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An electronic patients chart is shown on the wall to a hospital room at the newly constructed Kaiser Permanente San Diego Medical Center hospital in San Diego, California April 17, 2017.  REUTERS/Mike Blake - RC1740CA8030
BPEA Article

All Medicaid expansions are not created equal: The geography and targeting of the Affordable Care Act

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Editor's Note:

This paper is part of the Fall 2019 edition of the Brookings Papers on Economic Activity, the leading conference series and journal in economics for timely, cutting-edge research about real-world policy issues. Research findings are presented in a clear and accessible style to maximize their impact on economic understanding and policymaking. The editors are Brookings Nonresident Senior Fellow and Northwestern University Professor of Economics Janice Eberly and Brookings Nonresident Senior Fellow and Harvard University Professor of Economics James Stock. Read summaries of all six papers from the journal here.

Summary

Craig Garthwaite, John Graves, Tal Gross, Zeynal Karaca, Victoria Marone, and Matthew J. Notowidigdo study the effect of the Affordable Care Act Medicaid expansion on hospital services, with a focus on the geographic variations of its impact, finding that it increased Medicaid visits, decreased uninsured visits, and lead the uninsured to consume more hospital services overall— primarily through outpatient visits to the ED for deferrable conditions. Notably, the authors found significant heterogeneity across Medicaid-expansion states with some experiencing large changes in utilization and others seeing little change.

Citation

Garthwaite, Craig, John Graves, Tal Gross, Zeynal Karaca, Victoria Marone, and Matthew J. Notowidigdo. 2019. “All Medicaid expansions are not created equal: The geography and targeting of the Affordable Care Act” BPEA Conference Draft, Fall.

Conflict of Interest Disclosure

Craig Garthwaite is a Herman R. Smith Research Professor at the Kellogg School of Management at Northwestern University; John Graves is an Associate Professor at Vanderbilt University School of Medicine;  Tal Gross is an Associate Professor of Markets, Public Policy & Law at the Questrom School of Business at Boston University; Zeynal Karaca is a senior economist and program director for market analytics and research at the Agency for Healthcare Research and Quality; Victoria Marone is a doctoral candidate at Northwestern University; Matthew Notowidigdo is an associate professor of economics and an associate professor of strategy at the Weinberg College of Arts and Sciences at Northwestern University. Beyond these affiliations, the authors did not receive financial support from any firm or person for this paper or from any firm or person with a financial or political interest in this paper. None of the authors of this paper are currently officers, directors, or board members of any organization with an interest in this paper. Beyond the Agency for Healthcare Research and Quality, whose data is utilized in this paper, no outside party had the right to review this paper before circulation. The views expressed in this paper are those of the author, and do not necessarily reflect any of the institutions affiliated with the authors.

Authors

Craig Garthwaite

Associate Professor of Strategy, Herman Smith Research Professor in Hospital and Health Services Management, & Director of Healthcare - Kellogg School of Management, Northwestern University

Tal Gross

Associate Professor,, Department of Markets, Public Policy & Law - Questrom School of Business, Boston University

Zeynal Karaca

Senior Economist, Program Director for Market Analytics and Research - Agency for Healthcare Research and Quality

Victoria Marone

Ph.D. Candidate - Department of Economics, Northwestern University

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