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The Hidden Subsidy of the Affordable Care Act

Liam Sigaud, Markus Bjoerkheim, Vitor Melo

arXiv 9 Jul 2024 · Econometrics

arXiv:2407.07217 · PDF · DOI · OpenAlex · Extracted main text

Abstract

Under the ACA, the federal government paid a substantially larger share of medical costs of newly eligible Medicaid enrollees than previously eligible ones. States could save up to 100% of their per-enrollee costs by reclassifying original enrollees into the newly eligible group. We examine whether this fiscal incentive changed states' enrollment practices. We find that Medicaid expansion caused large declines in the number of beneficiaries enrolled in the original Medicaid population, suggesting widespread reclassifications. In 2019 alone, this phenomenon affected 4.4 million Medicaid enrollees at a federal cost of $8.3 billion. Our results imply that reclassifications inflated the federal cost of Medicaid expansion by 18.2%.

Citation extraction

60
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appendix boundary found by appendix_titled_section at “Appendix” · 91% of the source is main text. Read the extracted text to check this.

Most heavily cited references

The works this paper leans on most, across its whole bibliography — not restricted to papers in our corpus. Ranked by composite intensity, which combines how often a work is mentioned, how many sections mention it, and how much of that falls in the main text rather than the appendix.

ReferenceIntensityMentionsSectionsMain text
1Callaway, B. and P. H. Sant’Anna (2021) Difference-in-differences with multiple time periods0.90912375%
2Bundorf, M. K. and D. P. Kessler (2022) The responsiveness of medicaid spending to the federal subsidy0.84333100%
3Frean, M., J. Gruber, and B. D. Sommers (2017) Premium subsidies, the mandate, and Medicaid expansion: Coverage effects of the Affordable Care Act0.84333100%
4Fritzsche, K., K. McNellis, and E. Vreeland (2019) Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2019 to 2029, Tech0.64422100%
5Truffer, C., J. Klemm, C. Wolfe, K. Rennie, and J. Shuff (2013) 2013 Actuarial Report on the Financial Outlook for Medicaid, Tech0.64422100%
6Truffer, C., K. Rennie, L. Wilson, and E. Eckstein (2018) 2018 Actuarial Report on the Financial Outlook for Medicaid, Tech0.64422100%
7Yocom, C (2020) Accuracy of Determinations and Efforts to Recoup Federal Funds Due to Errors, Tech0.64422100%
8Gruber, J. and B. D. Sommers (2020) Fiscal federalism and the budget impacts of the Affordable Care Act's Medicaid expansion, Tech0.64422100%
9Hudson, J. L. and A. S. Moriya (2017) Medicaid expansion for adults had measurable ‘welcome mat’ effects on their children0.64422100%
10Levy, H., J. Z. Ayanian, T. C. Buchmueller, D. R. Grimes, and G. Ehr… (2020) Macroeconomic feedback effects of Medicaid expansion: Evidence from Michigan0.64422100%

Showing the top 10 of 60 scored citations.