Who did the ACA Medicaid expansion impact? Estimating the probability of being a complier.

Abstract

Who enrolled in Medicaid as a consequence of the Affordable Care Act (ACA)? Using the 2010-2017 American Community Survey, I estimate how characteristics relating to work status and race/ethnicity affect the probability that an individual will be a complier, defined as those induced by the ACA Medicaid expansion to obtain Medicaid coverage. Across all states, I find that part-time workers, not non-workers, are the most likely to be compliers. This finding is not consistent with certain notions that Medicaid participants are the "undeserving poor" - a sentiment that may have hindered efforts to expand Medicaid in certain states. Additionally, I find that in non-expansion states, many of which have high Black populations, the probability of being a complier is higher for Blacks than for other racial/ethnic groups, suggesting that Black people in non-expansion states would be the largest beneficiaries of any new expansions. This paper not only identifies the types of individuals who were already impacted by the expansion but also identifies which populations would benefit the most from subsequent expansions.