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AbstractWhen women of childbearing age gain health insurance, comparing birth outcomes that occur before and after policy changes may confound two separate impacts of coverage. Health insurance could affect who gives birth and also directly improve maternal and child health. We address this question using the Affordable Care Act young adult provision, comparing birth outcomes of 24–25 years to outcomes among older young adults. We show that the composition of mothers shifted toward less advantaged groups. Accounting for this shift, we find direct improvements in prenatal care and pregnancy‐related health but no statistically significant improvements in infant health.

AbstractDecentralized government is hypothesized to lead public service investments to better align with political preferences across geographical regions, yet there has been limited rigorous testing of this hypothesis. We examine how local public provision of hospital services varied according to political preferences between 2006 and 2016. We use state Medicaid expansion under the Affordable Care Act (ACA) as a source of exogenous variation. Consistent with the motivation for federalism, we find that areas less supportive of the ACA tended to convert the state expansion into lower property taxes with lower public hospital expenditures, whereas, in states that expanded Medicaid, local governments tended to increase public provision of healthcare.

AbstractThe U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA‐facilitated state‐level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference‐in‐differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self‐assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low‐income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self‐assessed health.