Preserving Progress: How Medicaid Expansion Improves Health Outcomes

Abstract

The expansion of Medicaid under the Affordable Care Act (ACA) significantly changed the landscape of health care policy in the United States. We address two central research questions: (1) Does Medicaid expansion help individuals access the care they need? (2) Does increased access to care lead to improved health outcomes? This thesis examines the effect of Medicaid expansion on health outcomes, focusing on three key dimensions: affordability of healthcare, healthcare utilization, and self-reported health. We pay particular attention to the population of individuals who newly qualify for Medicaid after their state adopted and implemented Medicaid expansion, hypothesizing that these individuals will see improved outcomes in their affordability of healthcare, utilization of preventive services (checkups), and their self-reported health. To conduct our analysis, we utilize a difference-in-differences (DiD) framework, where we compare changes in health outcomes between the years 2013, before Medicaid expansion, and 2017, three years after expansion, across individuals residing in states that adopted Medicaid expansion during that period and those in states that did not. Data from our analysis was derived from the nationally conducted Behavioral Risk Factor Surveillance System survey, which we utilize to categorize and assess individuals based on their Medicaid eligibility status. Our results find that, for individuals who became newly eligible for Medicaid after their state adopted expansion, for individuals who became newly eligible for Medicaid under expansion, Medicaid expansion significantly reduced the likelihood of reporting financial difficulties concerning healthcare and significantly improved the likelihood of reporting a recent checkup and reporting better self-reported health. These findings suggest that Medicaid expansion has been effective in improving the health outcomes of affected individuals, and that a rollback in expansion may lead to a reversion in these benefits. From a policy perspective, we argue against federal funding cuts to Medicaid, highlighting the economic benefits provided by Medicaid via job creation and GDP growth. We suggest introducing state-level tax increases as a viable alternative method to maintain Medicaid coverage while accommodating for the reductions in federal expenditure.