Good for your fiscal health? The effect of the affordable care act on healthcare borrowing costs

• 成果类型: Article
• 署名作者: Gao, Pengjie; Lee, Chang; Murphy, Dermot
• 署名单位: University of Notre Dame; Korea Advanced Institute of Science & Technology (KAIST); University of Illinois System; University of Illinois Chicago; University of Illinois Chicago Hospital
• 刊物名称: JOURNAL OF FINANCIAL ECONOMICS
• ISSN/ISSBN: 0304-405X
• DOI: 10.1016/j.jfineco.2021.09.003
• 发表日期: 2022
• 页码: 464-488
• 关键词: Public finance; Health economics; municipal bonds; Affordable Care Act; medicaid

摘要

We study the effect of the US Affordable Care Act (ACA) on healthcare borrowing costs. The ACA provides insurance subsidies to low-income enrollees. States could accept funding to expand Medicaid, although many declined, citing the cost burden. The ACA significantly reduced healthcare yields after a favorable 2012 Supreme Court ruling. Furthermore, hospital investment spending increased, and investment-cash flow sensitivities decreased. The yield effect was double in Medicaid expansion states, and insignificant in rural areas of non-expansion states. Our results highlight how the municipal market can be used to evaluate the heterogeneous effects of public policy and guide a targeted policy approach. (C) 2021 Elsevier B.V. All rights reserved.