The Effect of the ACA Medicaid Expansion on Marriage Behavior

Abstract

paper investigates the impact of the 2014 Medicaid expansions on marital behavior. The Patient Protection and Affordable Care Act (ACA) encouraged states to expand Medicaid and thereby increase insurance options for low-income individuals. Contributing to earlier work showing evidence of a link between insurance coverage and incentives to marry, we test whether the Medicaid expansions affected marriage and divorce decisions. Using data from the American Community Survey from 2008 to 2018 and estimating difference-in-differences models, we test the impact of Medicaid expansion on both stock and flow marital outcomes. As a first-stage effect, we show that the expansions increased Medicaid coverage by 31.15 percent in first-time expansion states. When evaluating the effects of the policy on marriage behavior, we find that Medicaid expansions led to a 0.75 percent reduction in the stock of married people, a 4.15 percent reduction in the likelihood of having married in the past year, and a 3.61 percent increase in having had a recent divorce. We believe the underlying mechanism to be twofold. First, Medicaid expansion led to increased insurance options, which decreased reliance on spousal health insurance coverage. Second, by changing eligibility thresholds, Medicaid led to people choosing to forego marriage or get divorced to meet post-policy program eligibility restrictions.