Inequality in health insurance coverage before and after the Affordable Care Act

This study examines how the Affordable Care Act (ACA) affected income related inequality in health insurance coverage in the United States. Analyzing data from the American Community Survey (ACS) from 2010 through 2018, we apply difference-in-differences, and triple-differences estimation to the Recentered Influence Function OLS estimation. We find that the ACA reduced inequality in health insurance coverage in the United States. Most of this reduction was a result of the Medicaid expansion. Additional decomposition analysis shows there was little change in inequality of coverage through an employer plan, and a decrease in inequality for coverage through direct purchase of health insurance. These results indicate that the insurance exchanges also contributed to declining inequality in health insurance coverage.

Automated summary

This study examined how the Affordable Care Act (ACA) impacted income-related inequality in health insurance coverage in the United States, finding that it reduced inequality primarily through the Medicaid expansion. There was little change in inequality for coverage through employer plans, but a decrease in inequality for coverage through direct purchase of health insurance. The results suggest that insurance exchanges also played a role in decreasing inequality in health insurance coverage.