Background
What is ACA also known as?
Obamacare
What years of data from the Behavioral Risk Factors Surveillance System were used in the analysis?
2010-2018
By how many percentage points did health insurance coverage increase in expansion states?
11.1 percentage points
How did the results compare to previous studies using fewer years of post-expansion data?
Showed more significant improvements in behaviors than past shorter-term studies.
What U.S. government agency oversees the Medicaid program?
Centers for Medicare and Medicaid Services
What is Medicaid?
The largest public health insurance in the U.S. for lower-income people.
What were the criteria used by the author to identify the studies reviewed in Table 1?
Keyword searches, type of study, outcomes examined
What types of preventive care did the author find significant increases in utilization of?
Routine checkups, HIV tests, dental visits
What mechanism did the author propose that may explain the findings?
Increased access to primary care providers
In what year were the majority of ACA's Medicaid expansions implemented?
2014
What does the author say is the relationship between income and preventive care utilization?
There is a strong positive correlation - lower-income people are less likely to get preventive care
What income restriction was applied to isolate the effect of Medicaid expansion?
Below 100% of federal poverty level
According to the results, how did heavy drinking change in years 4-5 after Medicaid expansion?
Decreased
What limitation of the data was highlighted in the discussion?
No source of insurance information to confirm Medicaid enrollment
Approximately how many U.S. states expanded Medicaid under the ACA?
36 states + Washington D.C.
According to the conceptual framework, how could health insurance both increase and decrease investments in health behaviors?
Price effects and information from providers could improve behaviors, but insurance could also cause ex-ante moral hazard.
Why does the author only examine individuals below 100% of the FPL (and not up to the complete 138% FPL that the expansion made eligible) ?
They did not want to conflate the effects of Medicaid expansion and exchange subsidies.
What did the event study analysis reveal about timing changes in health behaviors?
The changes emerged in years 4-5 after expansion.
Can the results for low-income childless adults generalize to other populations? Explain your answer
No
What health insurance program in the U.S. does Medicaid provide?
Public health insurance for low-income individuals
What explains why health behaviors may respond slower to policy changes than short-term responses would suggest?
Factors like addiction and inertia mean behaviors are slow to respond.
What assumptions did the parallel trends analysis test, and what was the result?
Tested pretreatment trends were parallel and found assumption satisfied for most outcomes.
Approximately what was the elasticity the author calculated for the effect of insurance on HIV testing?
0.38
What long-term implication for research does the author emphasize based on the findings?
Importance of longer post-treatment periods to evaluate total effects.
According to the paper, what was a limitation of using the Behavioral Risk Factors Surveillance System (BRFSS) data?
It does not record the source of health insurance