Association for Public Policy Analysis & Management

Panel: Insurance Coverage, Take-up, and the Affordable Care Act

(Health Policy)

The Affordable Care Act (ACA) expanded insurance coverage through Medicaid, the Marketplace, financial incentives, and mandated access to parental employer-sponsored insurance for young adults. This panel provides new evidence from four surveys and diverse methods on how well the expansions worked, potential mechanisms behind those effects, and the quality of the survey data used to analyze those effects. This panel directly links this excellent research to two practitioners, discussants from the Congressional Budget Office and the Medicaid and CHIP Payment and Access Commission. “Characteristics of Marketplace Enrollees: Changes over Time and Differences Across States” analyzes the first two years of Marketplace coverage. It studies outcomes significant for federal policy: enrollment, continuity of coverage, the characteristics of enrollees, their access to care, and the affordability of their care. Importantly, using the large sample in the National Health Interview Survey, it provides new information on the interactions between the Marketplace and Medicaid expansions that may help state policymakers better understand the broader impacts of their decisions on whether to expand Medicaid. “Effects of Marketplace Premiums on Uninsurance” focuses on the role of subsidized health insurance premiums in reducing uninsurance under the ACA. Using the 2014 Medical Expenditure Panel Survey and a detailed simulation model to determine the out-of-pocket premiums sample members faced in the Marketplace, this paper provides the first estimates of the effects of out-of-pocket premiums on uninsurance under the ACA. Policymakers can use this information to modify the ACA’s premium tax credits. “Concordance of ACS and Administrative Counts of Medicaid/CHIP Enrollment Over Time: Implications for Research and Evaluation of the Affordable Care Act” provides the foundation for assessing the effect of the ACA’s Medicaid expansion on Medicaid enrollment. Specifically, it compares administrative enrollment data and responses to the American Community Survey (ACS) state-by-state and over time. Concordance has changed over time and appears to be related to state policy decisions, which suggests the ACS can best be used to evaluate the ACA if it is linked to administrative data. This methodological finding must underpin efforts to provide the best possible research to policymakers. “Medicaid Adult Dental Benefits and Program Participation” analyzes the effect of benefits on Medicaid enrollment. Using state and year fixed effects models and 13 years of the Current Population Survey, the analysis shows that adult enrollment is Medicaid is greater, and uninsurance is lower, in states that offer adult preventive care. The ACA does not require states to provide adult dental coverage in their Medicaid programs, and this research may aid state policymakers in their decisions on which benefits their Medicaid programs should provide.