Association for Public Policy Analysis & Management

Panel: Medicaid Expansions and Socioeconomic Disparities

(Health Policy)

Health insurance is associated with a variety of positive consequences including improved health outcomes and financial security, which are intrinsically linked to the decisions individuals make regarding education, employment, and retirement. Thus, access to affordable health insurance may be a vital factor shaping decisions that can directly influence an individual’s socioeconomic status, especially for individuals already at a high risk of being uninsured. This panel will present findings from four papers that examine the extent to which expanding the availability of affordable health insurance through Medicaid expansions has had an effect on socioeconomic disparities in terms of education, retirement, and health insurance outcomes.

The first paper of the panel, “The Three Year Impact of the ACA on Disparities in Insurance Coverage,” provides evidence that the ACA Medicaid expansions played a large role in reducing health insurance coverage disparities between those with incomes below 138% FPL and those above 400%, whites and non-whites, married and unmarried people, and young adults and older nonelderly adults. Having established that Medicaid expansions help close the gap in health insurance access, the remaining papers in the panel examine whether expanding Medicaid also affects labor market decisions for these vulnerable populations, which may play a role in closing other existing socioeconomic disparities.

The next paper in the panel, “Public Health Insurance, Health Status, and Retirement Decisions” explores whether expanding Medicaid eligibility disincentivizes work and affects the retirement decisions of adults ages 50 to 64. This paper examines the state Medicaid expansions to non-elderly, non-disabled adults that occurred from 1996 to 2014.

The final two papers in the panel examine the impact of the Medicaid expansions on higher education. In “The Affordable Care Act and the Market for Higher Education,” the authors examine how the ACA has impacted college enrollment and find evidence that counties that are exposed more to the ACA and Medicaid expansion see higher enrollment in 2-year for-profit colleges than counties with lower exposure. In “Health insurance Access and the Academic Performance and Degree Completion of College Students”, the authors explore whether the ACA Medicaid expansions lead to improved academic performance and progress toward degree completion for those enrolled in college. Their analysis has a particular focus on independent or low-income students, who are most likely to be burdened by health insurance and health care costs and also most at risk of dropping out.