Medicaid Coverage and Health Outcomes: Evidence from Tennessee
In this study, I provide evidence on the impact of Medicaid coverage on health outcomes using a policy change in 2005 which led to the disenrollment of approximately 170,000 individuals from Tennessee’s Medicaid program. Previous research on the impact of this policy change has identified significant increases in employment primarily to secure private insurance coverage and increases in uninsured inpatient stays primarily originating in the emergency department. However, to the best of my knowledge, its impact on health outcomes has not been studied. This study examines the extent to which loss of Medicaid coverage due to the 2005 policy change affected self-rated physical and mental health and mortality. Data on self-rated health is obtained from the Behavioral Risk Factor Surveillance System (BRFSS) while information on mortality is obtained from the Compressed Mortality Files provided by the National Center for Health Statistics (NCHS).
To identify causal effects, I use a difference-in-differences approach that compares changes in health outcomes before and after the policy change in 2005 between Tennessee and other comparison states. Following prior work on this policy, I use multiple approaches to constructing the comparison group. I first include all states in the US and then restrict the comparison group to southern states. Next, I use a synthetic control method that uses a weighted average of comparison states to address differences between Tennessee and the control group. Finally, I use a triple difference approach that compares non-elderly individuals who were primarily affected by the policy change to elderly persons who were not. Preliminary findings provide some evidence that health status worsened due to the loss of coverage. I discuss the implications of my findings for the populations affected by the Medicaid expansions under the ACA.