Drawbacks and Aftermath of the Affordable Care Act: Ex-ante Moral Hazard and Inequalities in Health Care Access

Overview

Journal J Public Health Res

Publisher Sage Publications

Specialty Public Health

Date 2021 May 7

PMID 33960183

Citations 1

Authors

Daniele Corso

Affiliations

Soon will be listed here.

Abstract

Background: Following the introduction of the Affordable Care Act, various studies have tried to identify the effects of the Reform, without reaching a clear consensus. The aim of this study was to investigate whether expansion of the Medicaid program has led to less inequality in access to health care and to a higher level of ex-ante moral hazard.

Design And Methods: The analysis was conducted on two-year longitudinal data (2014-2015) regarding a cohort of 15,898 individuals from a Medical Expenditure Panel Survey (MEPS). After a data cleaning procedure, a sample of 9,255 individuals was selected for the inequality part of the study and 2,307 for the ex-ante moral hazard analysis. Propensity score matching with nearest-neighbour and kernel matching algorithms, difference-in-difference models and concentration index, corrected according to Erreygers methodology, were adopted.

Results: The analysis showed that disparities were reduced between social classes although the ex-ante moral hazard is a real problem with the Affordable Care Act since individuals covered by public insurance tended to abuse the public service. Among those who benefited from the Act, a reduction in preventive behaviours was observed: there was an increase in smoking and a decrease in level of physical activity. As far as concerns access to health care, there was a decrease in inequality in emergency visits, inability to get care and getting care when needed among beneficiaries of the Reform.

Conclusions: This study demonstrates that the extension of Medicaid has had a dual effect of reducing disparities in access to health care but, at the same time, it seems to have induced people to take less care of themselves.

Citing Articles

A systematic review of strategies used for controlling consumer moral hazard in health systems.

Koohi Rostamkalaee Z, Jafari M, Gorji H BMC Health Serv Res. 2022; 22(1):1260.

PMID: 36258192 PMC: 9580205. DOI: 10.1186/s12913-022-08613-y.

References

Dimick J, Ryan A . Methods for evaluating changes in health care policy: the difference-in-differences approach. JAMA. 2014; 312(22):2401-2. DOI: 10.1001/jama.2014.16153. View

Simon K, Soni A, Cawley J . The Impact of Health Insurance on Preventive Care and Health Behaviors: Evidence from the First Two Years of the ACA Medicaid Expansions. J Policy Anal Manage. 2017; 36(2):390-417. DOI: 10.1002/pam.21972. View

Cotti C, Nesson E, Tefft N . Impacts of the ACA Medicaid expansion on health behaviors: Evidence from household panel data. Health Econ. 2018; 28(2):219-244. DOI: 10.1002/hec.3838. View

Cossrow N, Falkner B . Race/ethnic issues in obesity and obesity-related comorbidities. J Clin Endocrinol Metab. 2004; 89(6):2590-4. DOI: 10.1210/jc.2004-0339. View

Baicker K, Taubman S, Allen H, Bernstein M, Gruber J, Newhouse J . The Oregon experiment--effects of Medicaid on clinical outcomes. N Engl J Med. 2013; 368(18):1713-22. PMC: 3701298. DOI: 10.1056/NEJMsa1212321. View

Courtemanche C, Marton J, Ukert B, Yelowitz A, Zapata D . Early Impacts of the Affordable Care Act on Health Insurance Coverage in Medicaid Expansion and Non-Expansion States. J Policy Anal Manage. 2016; 36(1):178-210. DOI: 10.1002/pam.21961. View

Garrido M, Kelley A, Paris J, Roza K, Meier D, Morrison R . Methods for constructing and assessing propensity scores. Health Serv Res. 2014; 49(5):1701-20. PMC: 4213057. DOI: 10.1111/1475-6773.12182. View

Finkelstein A, Taubman S, Wright B, Bernstein M, Gruber J, Newhouse J . THE OREGON HEALTH INSURANCE EXPERIMENT: EVIDENCE FROM THE FIRST YEAR. Q J Econ. 2013; 127(3):1057-1106. PMC: 3535298. DOI: 10.1093/qje/qjs020. View

Sommers B, Blendon R, Orav E, Epstein A . Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Intern Med. 2016; 176(10):1501-1509. DOI: 10.1001/jamainternmed.2016.4419. View

10.

Kino S, Kawachi I . The impact of ACA Medicaid expansion on socioeconomic inequality in health care services utilization. PLoS One. 2019; 13(12):e0209935. PMC: 6312270. DOI: 10.1371/journal.pone.0209935. View

11.

Kassel J, Stroud L, Paronis C . Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull. 2003; 129(2):270-304. DOI: 10.1037/0033-2909.129.2.270. View

12.

Seo V, Baggett T, Thorndike A, Hull P, Hsu J, Newhouse J . Access to care among Medicaid and uninsured patients in community health centers after the Affordable Care Act. BMC Health Serv Res. 2019; 19(1):291. PMC: 6505197. DOI: 10.1186/s12913-019-4124-z. View

13.

Wagstaff A, Doorslaer E, Paci P . On the measurement of horizontal inequity in the delivery of health care. J Health Econ. 1991; 10(2):169-205; discussion 247-9, 251-6. DOI: 10.1016/0167-6296(91)90003-6. View

14.

Koolman X, van Doorslaer E . On the interpretation of a concentration index of inequality. Health Econ. 2004; 13(7):649-56. DOI: 10.1002/hec.884. View

15.

Assaf S, Campostrini S, Di Novi C, Xu F, Gotway Crawford C . Analyzing disparity trends for health care insurance coverage among non-elderly adults in the US: evidence from the Behavioral Risk Factor Surveillance System, 1993-2009. Eur J Health Econ. 2016; 18(3):387-398. PMC: 10884940. DOI: 10.1007/s10198-016-0806-1. View

16.

Spenkuch J . Moral hazard and selection among the poor: evidence from a randomized experiment. J Health Econ. 2012; 31(1):72-85. DOI: 10.1016/j.jhealeco.2011.12.004. View

17.

Moran S, Wechsler H, Rigotti N . Social smoking among US college students. Pediatrics. 2004; 114(4):1028-34. DOI: 10.1542/peds.2003-0558-L. View

18.

Egli T, Bland H, Melton B, Czech D . Influence of age, sex, and race on college students' exercise motivation of physical activity. J Am Coll Health. 2011; 59(5):399-406. DOI: 10.1080/07448481.2010.513074. View

19.

Erreygers G . Correcting the concentration index. J Health Econ. 2008; 28(2):504-15. DOI: 10.1016/j.jhealeco.2008.02.003. View

20.

Han X, Nguyen B, Drope J, Jemal A . Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States. PLoS One. 2016; 10(12):e0144429. PMC: 4700996. DOI: 10.1371/journal.pone.0144429. View