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Title: Labor Market and Outreach Effects of Medicaid Expansion Under the Affordable Care Act

Citation Type: Dissertation/Thesis

Publication Year: 2018

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Abstract: The Affordable Care Act’s (ACA) Medicaid expansion is unique in terms of expanding coverage to adults without dependent children (“childless adults”) and increasing community-based outreach to raise awareness about coverage options. This dissertation explores the labor market and outreach effects of the ACA’s Medicaid expansion on childless adults and parents, respectively. First chapter of the dissertation investigates the pre/post labor market implications of the ACA’s Medicaid expansion for a population near the income eligibility cutoff. Using an arguably exogenous variation at this cutoff, I find that Medicaid enrollment increases for childless adults. This leads to an employment transition from full-time (≥35 Hrs) to part-time employment (<35 Hrs) after the expansion. The employment transition is mainly driven by the increase in employment for working less than 20 hours. These findings support the presence of employment lock – individuals who are employed primarily to retain health benefits. Replication of existing studies that used difference-in-differences (DD) models with expansion states as the treatment yield no employment effects. The treatment group in these models, however, is large and heterogeneous. In the second chapter, I assess the effect of the ACA’s Medicaid expansion on the retirement decision of low-income adults aged 55 to 64 years. This chapter also focuses on childless adults, a group that gained access to Medicaid coverage after the ACA. Using an instrumental variables (IV) model that exploits both the expansion decision of states and timing, I find that the probability of retirement increases by 14.8 percentage points for childless adults with Medicaid. The probability of retirement increases by 13.4 and 16.1 percentage points for men and women, respectively. In the last chapter, I show the effect of information on Medicaid enrollment of previously-eligible parents (“woodwork effect”). Previous studies that analyze the changes in Medicaid take-up often ignore potential outreach effects. After controlling for the change in income eligibility limits, I find that woodwork effects are stronger in hard-to-reach communities that consist of low-educated, Hispanic, and non-white parent groups. In addition, woodwork effects increase enrollment in non-expansion states, particularly in states that have high search volume of Medicaid. Overall, the findings support the presence of information spillovers under the ACA’s Medicaid expansion.

Url: https://preserve.lehigh.edu/cgi/viewcontent.cgi?article=5267&context=etd

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Authors: Aslim, Erkmen, G

Institution: Lehigh University

Department: Business and Economics

Advisor: Shin-Yi Chou

Degree: Doctor of Philosophy

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Pages: 117

Data Collections: IPUMS USA

Topics: Health, Labor Force and Occupational Structure, Population Health and Health Systems

Countries: United States