Impacts of the Affordable Care Act Medicaid Expansion in California (CJPP)
This Journal article was originally published in the California Journal of Politics and Policy.
A cornerstone aim of the Affordable Care Act (ACA) was to make health insurance coverage readily available to more people in the United States through policies such as new federal subsidies to help people with moderate incomes purchase private insurance through new Marketplaces and expanding Medicaid’s reach to many more low-income adults. Key components of the ACA were implemented in 2014, including state-level expansions of Medicaid. Studies that compared states that opted for and against expanding their Medicaid programs have documented gains in coverage, access, and health status particularly among low-income and childless adults, who were the main subpopulation beneficiaries of Medicaid expansion in states that adopted it.i However, few of these studies have focused specifically on California. To our knowledge, past studies on the effects of Medicaid expansion in California have not examined self-reported general health and physical/mental health for low-income adults. Self-reported health measures are important for monitoring population health over time, quantifying individual satisfaction with health, and complementing objective long-term outcomes such as mortality.ii
This journal article authored by SHADAC researchers Natalie Schwehr, Giovann Alarcón, and Lacey Hartman examines the impact of the Affordable Care Act (ACA) on healthcare coverage, access, health status, and affordability, as well as disparities in these outcomes by race/ethnicity among low-income Californians.
Using nationally representative survey data from the Behavioral Risk Factor Surveillance Survey 2011-2019 and a difference-in-differences approach that compared California with nonexpansion states, they examined the impact of Medicaid expansion on health insurance coverage, having a usual source of care, self-reported health status, frequent (≥14) unhealthy days in the past month (physical, mental, and both), and foregone care due to cost.
The sample population included low-income Californians (<100% of the federal poverty guidelines) aged19-64 and low-income childless adults.
- Low-income adults, childless adults, and white childless adults in California saw post-ACA gains in six of seven outcomes, including a 7.7 percentage point increase in having a usual source of care for all low-income adults.
- Childless adult people of color (POC) reported significant improvements in three measures, with a 6.6 percentage point increase in having a usual source of care (CI: 0.013 to 0.120).
- All groups examined had coverage gains, ranging from 3.9 percentage points for all low-income adults, to 8.4 percentage points for white childless adults.
- All groups reported improved mental health, including an 8.2 percentage point decrease in frequent mental distress for childless adults.
These findings indicate that the ACA coverage expansion benefitted the targeted population of low-income Californians. Additionally, the disparity between white and non-white Californians decreased for the unadjusted mean rate of having a usual source of care. However, unadjusted means showed that white low-income adults remained more likely to have health insurance coverage and a usual source of care compared with POC in both California and nonexpansion states.
Read the full article in the California Journal of Politics and Policy, or download it here.
Schwehr, N., Alarcón, G., & Hartman, L. (2021). Impacts of the Affordable Care Act Medicaid Expansion in California. California Journal of Politics and Policy, 13(1). http://dx.doi.org/10.5070/P2cjpp13154573 Retrieved from https://escholarship.org/uc/item/17d520j7
i Simon, Kosali, Aparna Soni, and John Cawley. 2017. “The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions.” Journal of Policy Analysis and Management36 (2): 390–417. https://doi.org/10.1002/pam.21972
ii Dwyer-Lindgren, Laura, Johan P. Mackenbach, Frank J. van Lenthe, and Ali H. Mokdad. 2017. “Self-Reported General Health, Physical Distress, Mental Distress, and Activity Limitation by US County, 1995-2012.” Population Health Metrics15 (1): 1–12. https://doi.org/10.1186/s12963-017-0133-5.