The consequences of Medicaid expansion under the Affordable Care Act for police arrests

Background & methods National protests in the summer of 2020 drew attention to the significant presence of police in marginalized communities. Recent social movements have called for substantial police reforms, including “defunding the police,” a phrase originating from a larger, historical abolition movement advocating that public investments be redirected away from the criminal justice system and into social services and health care. Although research has demonstrated the expansive role of police to respond a broad range of social problems and health emergencies, existing research has yet to fully explore the capacity for health insurance policy to influence rates of arrest in the population. To fill this gap, we examine the potential effect of Medicaid expansion under the Affordable Care Act (ACA) on arrests in 3,035 U.S. counties. We compare county-level arrests using FBI Uniform Crime Reporting (UCR) Program Data before and after Medicaid expansion in 2014–2016, relative to counties in non-expansion states. We use difference-in-differences (DID) models to estimate the change in arrests following Medicaid expansion for overall arrests, and violent, drug, and low-level arrests. Results Police arrests significantly declined following the expansion of Medicaid under the ACA. Medicaid expansion produced a 20–32% negative difference in overall arrests rates in the first three years. We observe the largest negative differences for drug arrests: we find a 25–41% negative difference in drug arrests in the three years following Medicaid expansion, compared to non-expansion counties. We observe a 19–29% negative difference in arrests for violence in the three years after Medicaid expansion, and a decrease in low-level arrests between 24–28% in expansion counties compared to non-expansion counties. Our main results for drug arrests are robust to multiple sensitivity analyses, including a state-level model. Conclusions Evidence in this paper suggests that expanded Medicaid insurance reduced police arrests, particularly drug-related arrests. Combined with research showing the harmful health consequences of chronic policing in disadvantaged communities, greater insurance coverage creates new avenues for individuals to seek care, receive treatment, and avoid criminalization. As police reform is high on the agenda at the local, state, and federal level, our paper supports the perspective that broad health policy reforms can meaningfully reduce contact with the criminal justice system under historic conditions of mass criminalization.

Bridging the Gulf on Health Care Policy Beyond the Affordable Care Act

This article presents a brief overview of the Affordable Care Act (ACA) and changes ushered into the health care system by the Act. The overview is followed by arguments for and against the ACA, integrating and situating the divergent arguments within the context of both democratic and conservative standpoints on health care policy. Furthermore, the article explores the possibility of identifying factors responsible for the seeming difficulty in transiting policy from agenda status to adoption in a democratic system of governance. The article concludes with suggestions on ways and strategies that can help in bridging the ostensible gap between divergent positions, with the hope of charting the course to the desired destination of an equitable and sustainable health care policy for the United States.

Effects of the 2014 Affordable Care Act Medicaid Expansions on Health Care Access and Health Status of Poor Adults Aged 60-64 Years: Evidence from the First Six Years

Background and Objectives Little is known on effects of the Affordable Care Act (ACA) Medicaid expansions on health care access and health status of adults closest to 65. This study examines the effects of ACA Medicaid expansion on access and health status of poor adults aged 60-64 years. Research Design and Methods The study employs a difference-in-differences design comparing states that expanded Medicaid in 2014 under the ACA and non-expansion states over six years post expansion. The data are from the 2011-2019 Behavioral Risk Factor Surveillance System for individuals aged 60–64 years below the Federal Poverty Level. Results Having any health care coverage rate increased by 8.5 percentage-points (p<0.01), while the rate of forgoing a needed doctor’s visit due to cost declined by 6.6 percentage points (p<0.01). Similarly, rates of having a personal doctor/provider and completing a routine checkup increased by 9.1 (p<0.01) and 4.8 (p<0.1) percentage-points, respectively. Moreover, days not in good physical health in the past 30 declined by 1.5 days (p<0.05), with suggestive evidence for decline in days not in good mental health and improvement in self-rated health. Discussion and Implications The ACA Medicaid expansions have improved health care access and health status of poor adults aged 60-64 years. Expanding Medicaid in the states that have not yet done so would reduce barriers to care and address unmet health needs for this population. Bridging coverage for individuals 60-64 years old by lowering Medicare eligibility age could have long-term effects on wellbeing and health services utilization.