The effect of health insurance coverage on personal bankruptcy: evidence from the Medicaid expansion

Abstract

This paper investigates the effects of health insurance coverage among low-income people on personal bankruptcies at the county level and the state level, based on the hypothesis that having health insurance reduces the risk of medical out-of-pocket spending and consequently decreases the likelihood of financial distress. In order to estimate the causal effects of health insurance coverage on personal bankruptcy, I exploit the Medicaid expansion under the Affordable Care Act as a source of exogenous variation in health insurance coverage and use it as an instrumental variable. Using bankruptcy filings from the US Court, I find that an increase in the share of low-income people with health insurance reduces Chapter 7 bankruptcy rates both at the county level and state level. The implied magnitudes of my estimated impacts are quantitatively important.