The Long-Run Effects of the Affordable Care Act: A Pre-Committed Research Design Over the Covid-19 Recession and Recovery

Abstract

The long-run costs and benefits of social insurance expansions may not be realized until a program has been in place through a cycle of boom, bust, and recovery. In the case of the Affordable Care Act (ACA), the arrival of the program's inaugural bust and recovery have been hastened by the COVID-19 pandemic. In this context, our analysis begins by developing two facts. First, during the pre-pandemic boom, we show that the ACA's effects had largely stabilized by 2016. Second, we develop a new fact involving variations in the ACA's effects across industries. Specifically, we show that the ACA’s effects differed dramatically across industries with lower versus higher levels of pre-ACA insurance coverage, and that this difference cannot be explained by differences in workers’ incomes or other observable characteristics, nor by geographic differences in pre-ACA uninsured rates. Finally, we set the stage for pre-committed analyses of the ACA's effects over the remainder of the current cycle of boom, bust, and recovery. In so doing, we seek to advance the use of pre-committed research designs in observational settings.