Demographics and the Insurance Decision: Examining the effect of Section 2001(a) temporally among demographics.

Abstract

This thesis analyzes the impartiality of the policy effect of Section 2001(a) of the Patient Protection and Affordable Care Act (“ACA”). Section 2001(a) amended the Social Security Act expanding Medicaid eligibility to those making up to 138% of the federal poverty line. To do so, this thesis focuses on the population making 100-138% of the federal poverty line and four different groups of states. These groups were non-expansion states (states where Medicaid was never expanded under Section 2001(a) of the ACA), traditional expansion states (states where Medicaid was expanded as intended by Section 2001(a) (i.e. beginning on January 1, 2014)), and two groups of “delayed expansion” states: 2015-expansion states, and 2016 expansion states. The research questions which this paper addresses are: 1. Were certain groups or demographics of the population in the 100-138% of the Federal Poverty Level effected differently by the Medicaid expansion policy of the ACA under Section 2001(a)? 2. Did a state’s temporal decision to expand Medicaid result in a substantial difference between the same demographic in a different group of states? 3. If either of the previous two questions are answered in the affirmative, did certain demographics behave differently across groups with respect to Medicaid participation? I find the legislative action of Section 2001(a) affected no demographic significantly differently than another. I also find that there is no substantial difference in Medicaid adoption between groups depending on expansion date if a state expanded Medicaid. In my findings, there is a puzzling trend occurring in the black and Hispanic demographics in delayed expansion states. These two demographics have decreases in the proportion occurring post-implantation in delayed expansionary environments. It is a puzzling trend I observe only occurs in the delayed expansion groups and only in the black and Hispanic demographics. I offer a specific explanation to why this may happen.