The Impact of the Affordable Care Act: Evidence from California's Hospital Sector

• 成果类型: Article
• 署名作者: Duggan, Mark; Gupta, Atul; Jackson, Emilie
• 署名单位: Stanford University; University of Pennsylvania; National Bureau of Economic Research
• 刊物名称: AMERICAN ECONOMIC JOURNAL-ECONOMIC POLICY
• ISSN/ISSBN: 1945-7731
• DOI: 10.1257/pol.20190279
• 发表日期: 2022
• 页码: 111-151
• 关键词: department visits evidence; health-insurance coverage; Medicaid expansion; access; eligibility; marketplace; mortality; QUALITY

摘要

We exploit changes in the discontinuity in health insurance coverage at age 65 induced by the implementation of the Affordable Care Act to examine effects on coverage, hospital use, and patient health. We then link these changes to effects on hospital finances. We show that a substantial share of the federally funded Medicaid expansion substituted for existing locally funded safety net programs. Despite this offset, the expansion produced a substantial increase in hospital revenue, reflected in an equivalent increase in operating surplus. We do not detect improvements in patient mortality, although the expansion led to substantially greater hospital and emergency room use.