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This paper examines the impact of Medicaid expansions to parents and childless adults on adult mortality. Specifically, we evaluate the long‐run effects of eight state Medicaid expansions from 1994 through 2005 on all‐cause, healthcare‐amenable, non‐healthcare‐amenable, and HIV‐related mortality rates using state‐level data. We utilize the synthetic control method to estimate effects for each treated state separately and the generalized synthetic control method to estimate average effects across all treated states. Using a 5% significance level, we find no evidence that Medicaid expansions affect any of the outcomes in any of the treated states or all of them combined. Moreover, there is no clear pattern in the signs of the estimated treatment effects. These findings imply that evidence that pre‐ACA Medicaid expansions to adults saved lives is not as clear as previously suggested.

Objective: To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on health care access and self-assessed health during the first 2 years of the Trump administration (2017 and 2018). Data Source: The 2011-2018 waves of the Behavioral Risk Factor Surveillance System (BRFSS), with the sample restricted to nonelderly adults. The BRFSS is a commonly used data source in the ACA literature due to its large number of questions related to access and self-assessed health. In addition, it is large enough to precisely estimate the effects of state policy interventions, with over 300 000 observations per year. Design: We estimate difference-in-difference-in-differences (DDD) models to separately identify the effects of the private and Medicaid expansion portions of the ACA using an identification strategy initially developed in Courtemanche et al (2017). The differences come from: (a) time, (b) state Medicaid expansion status, and (c) local area pre-2014 uninsured rates. We examine ten outcome variables, including four measures of access and six measures of self-assessed health. We also examine differences by income and race/ethnicity. Principal Findings: Despite changes in ACA administration and the political debate surrounding the ACA during 2017 and 2018, including these fourth and fifth years of postreform data suggests continued gains in coverage. In addition, the improvements in reported excellent health that emerged with a lag after ACA implementation continued during 2017 and 2018. Conclusions: While gains in access and self-assessed health continued in the first 2 years of the Trump administration, the ongoing debate at both the federal and state level surrounding the future of the ACA suggests the need to continue monitoring how the law impacts these and many other important outcomes over time. KEYWORDS access to care, affordable care act, health, health care access, health insurance, medicaid expansions, self-assessed health, self-reported health, 1 | INTRODUCTION In 2014, the major components of the Affordable Care Act (ACA), including the individual mandate, subsidized Marketplace coverage, and state Medicaid expansions, were implemented. (1-3) A recently [...]

Objective: To estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after three years.Data Source: The 2011-2016 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults.Design: We estimate a difference-in-difference-in-differences model to separately identify the effects of the nationwide and Medicaid expansion portions of the ACA using the methodology developed in the recent ACA literature. The differences come from time, state Medicaid expansion status, and local area pre-ACA uninsured rates. In order to focus on access disparities, we stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography.Principal Findings: After three years, the fully implemented ACA eliminated 43% of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 23%, across marital status by 46%, and across age-groups by 36%, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.Conclusions: The fully implemented ACA has been successful in reducing coverage disparities across multiple groups.KEYWORDSgender/sex differences in health and health care, health care financing/insurance/premiums, health policy/politics/law/regulation, medicaid, racial/ethnic differences in health and health care, state health policies, 1 | INTRODUCTIONPrior to the implementation of the primary components of the Affordable Care Act (ACA) in 2014, there were well-documented disparities in insurance coverage along multiple dimensions, such as [...]