Absence of conflict of interest.
The study's objective was to examine the impact of state Medicaid expansion (following the Affordable Care Act) on re-employment trends among unemployed adults in expansion and non-expansion states.
The authors used a difference-in-difference design to estimate the impacts of state Medicaid expansion from the Affordable Care Act on employment, using labor participation data from the 2007 to 2017 Current Population Survey (CPS). They used a statistical model to compare employment over time in states that did and did not implement Medicaid expansion.
The study did not find any statistically significant evidence of negative effects of state Medicaid expansion eligibility on job search and employment among unemployed adults when leaving unemployment.
The quality of causal evidence presented in this report is moderate because it was based on a well-implemented non-experimental design. This means we are somewhat confident that the estimated effects are attributable to Medicaid expansion, but other factors may have also contributed.
State Medicaid expansion following the Affordable Care Act
Features of the Intervention
Medicaid coverage under the Affordable Care Act (ACA) aimed to provide health insurance to all individuals from 19 to 64 in families with incomes below 138% of the federal poverty line. In 2012, the Supreme Court ruled that states had the right to opt out of the Medicaid expansion described within ACA. In January 2014, the extended federal unemployment insurance benefits under the 2008 Emergency Unemployment Compensation program expired. By January 2014, 24 states had implemented state Medicaid expansion; by January 2017, seven additional states followed, for a total of 31 states. As of January 2019, 19 states had not implemented an expansion to Medicaid under the ACA. Individuals just below a state's income eligibility cutoff prior to expansion are covered after expansion, which may increase employment since these individuals may now earn more income without fear of losing health coverage. However, individuals just above the new cutoff may exit employment to become eligible for Medicaid.
Features of the Study
The authors estimated a difference-in-differences regression model using individual-level monthly Current Population Survey labor participation force data from 2007 to 2017. The analysis estimated impacts of state Medicaid expansion on unemployed adults. The outcome of interest was reemployment. Impacts were identified as the difference between changes in reemployment for individuals residing in states that had and had not yet implemented state Medicaid expansion. The regression models controlled for age, educational attainment, race/ethnicity, gender, marital status, state unemployment rates, and state average number of weeks of unemployment insurance benefits available.
- The study found that no impact of state Medicaid expansion following the Affordable Care Act on reemployment.
Considerations for Interpreting the Findings
Although the study used a well-implemented non-experimental design, there is one issue that should be considered when interpreting the findings. During the consecutive four-month data collection period, some study participants opted out of receiving unemployment insurance for one month due to various reasons but returned the next month to resume participating. These cases were coded as “no transitions.” Results are based on these data, which may be less precisely estimated than when this coding is not used.
Causal Evidence Rating
The quality of causal evidence presented in this report is moderate because it was based on a well-implemented non-experimental design. This means we would be somewhat confident that any estimated effects would be attributable to state Medicaid expansions but other factors might also have contributed. However, the study did not find statistically significant effects.