The effect of the affordable care act and racial dynamics on federal Medicaid transfers

The Affordable Care Act (ACA) was intended to reduce inequalities in access to healthcare resources. However, a 2012 Supreme Court decision allowed states to opt out of a key component of the policy, leading to even greater variation in Medicaid’s implementation. Using this variation, we estimate th...

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Bibliographic Details
Published in:Journal of public policy 2023-09, Vol.43 (3), p.533-555
Main Authors: Olvera, Johabed G., Smith, Candis Watts, vonLockette, Niki D.
Format: Article
Language:English
Subjects:
African Americans
Black people
Counties
Demographics
Empowerment
Ethnicity
Federalism
Health care access
Health care policy
Health insurance
Inequality
Low income groups
Medicaid
Patient Protection & Affordable Care Act 2010-US
Politics
Population
Race
Residents
Segregation
Specification
Supreme Court decisions
Supreme courts
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Summary:The Affordable Care Act (ACA) was intended to reduce inequalities in access to healthcare resources. However, a 2012 Supreme Court decision allowed states to opt out of a key component of the policy, leading to even greater variation in Medicaid’s implementation. Using this variation, we estimate the effect of the ACA Medicaid expansion and racial dynamics on federal Medicaid-CHIP transfers received by states at the county level. To do so, we use a difference-in-differences specification and allow the expansion effect to vary across counties with different population shares of Black Americans. We find that Medicaid expansion increases the funds that are sent to counties, but additional analyses show that the racial demographics of a county also serve to influence how federal resources are apportioned. Specifically, the analyses reveal a curvilinear relationship between the proportion of Black residents and the dispersal of funds.
ISSN:0143-814X
1469-7815
DOI:10.1017/S0143814X23000090