Panel Paper:
The Effect of ACA Medicaid Expansions for Adults on Insurance Coverage for Low-Income Children
*Names in bold indicate Presenter
This paper investigates the potential for “welcome mat” effects under the ACA. In particular, we observe publicly eligible children and measure the impact of Medicaid expansions for adults on the probability that a child enrolls in public coverage. Using data from 2013 and 2014, we take advantage of the natural experiment created by the Supreme Court decision that allowed states to choose whether or not to expand Medicaid to adults. We use a difference-in-differences model to compare changes in eligible children’s coverage between 2013 and 2014 in Expansion-states vs. Non-expansion-states.
We use data from the American Community Survey (ACS), currently the largest household survey in the U.S. In 2014, the ACS public use sample included 708,121 children. The ACS contains rich information on demographic, socioeconomic, geographic, and health characteristics, including income, citizenship, disability, and health insurance coverage. The information enables us to determine the eligibility of Medicaid (and CHIP) and the types of insurance coverage held for both children and their parents.
Preliminary results suggest the presence of welcome mat effects of the ACA. Medicaid eligible children living in families with income below 138% FPL had increased take-up rates in 2014 compared to 2013. Increases were present for children regardless of their state’s ACA Expansion status, but changes in take-up were larger among children living in Expansion-states. Welcome mat effects persisted even among eligible children living in families with incomes above 138% FPL. Children living in expansion states had significantly larger increases in take-up than those in non-expansion-states.