Association for Public Policy Analysis & Management

The 2010 Patient Protection and Affordable Care Act (PPACA) expanded access to health insurance for much of the US population. The law provided subsidies for private health insurance purchased on State or Federally run marketplaces as well as coverage under Medicaid. The law substantially reduced the rate of un-insurance, however, many groups were excluded from the expansion of Medicaid. In particular, recent immigrants in many states remained ineligible for Medicaid. This analysis will quantify the extent to which the PPACA expanded health insurance coverage, and how recent immigrants were excluded from this expansion. The law is largely seen as a step towards universal healthcare coverage, but with key populations excluded, this is not the case.

This paper will examine the differential effects of the PPACA on poverty, inequality, and economic wellbeing. The differential policy changes allow for a policy evaluation of the effect of Medicaid expansion (and access to health insurance generally) on economic wellbeing and inequality. The primary sources of variation come from the “5-year-bar” which prohibits many immigrants who have been in the country for 5 years or fewer from receiving Medicaid. Additionally, there are state-level policy differences following the enactment of the PPACA.

Using the American Community Survey, I will examine the impact of Medicaid (and affordable health insurance generally) on measures of economic wellbeing and inequality. Primarily, the supplemental poverty measure and other expanded measures of poverty offer a multi-dimensional measure of poverty and relative deprivation. In addition to these outcomes, I will examine labor market responses, as the expansion of government-provided health insurance coverage may reduce the pressure to be employed in a job that offers employer-provided insurance. Finally, in revealing where the PPACA falls short in covering recent immigrants, the paper will provide policy solutions to remedy this hole in the social safety net.