All Medicaid Expansions are Not Created Equal: The Geography and Targeting of the Affordable Care Act

91 Pages Posted: 14 Oct 2019 Last revised: 8 Jul 2023

See all articles by Craig Garthwaite

Craig Garthwaite

Northwestern University; National Bureau of Economic Research (NBER)

John Graves

Vanderbilt University

Tal Gross

Columbia University - Department of Health Policy and Management

Zeynal Karaca

U.S. Department of Health and Human Services

Victoria Marone

Northwestern University

Matthew Notowidigdo

University of Chicago - Booth School of Business

Date Written: September 2019

Abstract

We use comprehensive patient-level discharge data to study the effect of Medicaid on the use of hospital services. Our analysis relies on cross-state variation in the Affordable Care Act’s Medicaid expansion, along with within-state variation across ZIP Codes in exposure to the expansion. We find that the Medicaid expansion increased Medicaid visits and decreased uninsured visits. The net effect is positive for all visits, suggesting that those who gain coverage through Medicaid consume more hospital services than they would if they remained uninsured. The increase in emergency department visits is largely accounted for by “deferrable” medical conditions. Those who gained coverage under the Medicaid expansion appear to be those who had relatively high need for hospital services, suggesting that the expansion was well targeted. Lastly, we find significant heterogeneity across Medicaid-expansion states in the effects of the expansion, with some states experiencing a large increase in total utilization and other states experiencing little change. Increases in hospital utilization were larger in Medicaid-expansion states that had more residents gaining coverage and lower pre-expansion levels of hospital uncompensated care costs.

Suggested Citation

Garthwaite, Craig and Graves, John and Gross, Tal and Karaca, Zeynal and Marone, Victoria and Notowidigdo, Matthew, All Medicaid Expansions are Not Created Equal: The Geography and Targeting of the Affordable Care Act (September 2019). NBER Working Paper No. w26289, Available at SSRN: https://ssrn.com/abstract=3469381

Craig Garthwaite (Contact Author)

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
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National Bureau of Economic Research (NBER)

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John Graves

Vanderbilt University ( email )

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Tal Gross

Columbia University - Department of Health Policy and Management ( email )

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New York, NY 10032
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HOME PAGE: http://www.talgross.com

Zeynal Karaca

U.S. Department of Health and Human Services ( email )

Agency for Healthcare Research and Quality
5600 Fishers Lane
Rockville, MD 20857
United States

Victoria Marone

Northwestern University ( email )

2001 Sheridan Road
Evanston, IL 60208
United States

Matthew Notowidigdo

University of Chicago - Booth School of Business ( email )

5807 S. Woodlawn Avenue
Chicago, IL 60637
United States

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