The Effect of the Affordable Care Act's Medicaid Expansion on the Mental Health Of Already-Enrolled Medicaid Beneficiaries

Abstract

The Affordable Care Act expanded health insurance coverage through Medicaid to 15 million low-income adults. While extensive research has shown Medicaid expansions improved access to care and health outcomes among the newly covered, less is known about the effects on those who were already covered by Medicaid. In this study, we use a difference-in-differences design to examine the impact of expansion on the self-reported general and mental health of near-elderly continuously covered Medicaid beneficiaries, using data from the Health and Retirement Study. We do not find consistent effects on general health. We find evidence of deteriorating mental health among original Medicaid beneficiaries. Our preferred estimate is a reduction of 0.51 point (10.9 percent) on the eight-point Center for Epidemiologic Studies Depression Index, and we find larger effects among important subgroups, including women (–1.10) and people with disabilities (–1.01). The effects are also larger in areas that experienced shortages of mental health workers after expansion and in nonmetropolitan counties. These results highlight the need for policymakers to consider potential negative spillover effects when expanding public insurance programs.

Note:

Funding Information: None.

Conflict of Interests: None.

Keywords: access to care, Affordable Care Act, health policy, Medicaid, Medicaid benefits, Medicaid and depression, Medicaid and mental health, Medicaid and older adults, Medicaid expansion, Medicaid expansion and mental health, Medicaid expansion original beneficiaries

JEL Classification: I11, I13, I18