The Effect of ACA Medicaid Expansion on Suicide

Economists and policymakers have long been interested in the relationship between health insurance and health outcomes. Several recent studies have used data gathered from the Oregon Health Insurance Experiment (Allen et al. 2012; Finkelstein et al. 2012) and the state level Medicaid expansions under the Affordable Care Act (Antwi, Moriya, & Simon 2013; Na & Slusky 2016; Wherry & Miller 2016) to explore access to healthcare and health outcomes. A great deal of this research has focused on physiological conditions, such as diabetes and heart disease. However, recent evidence suggests some of the main factors influencings life expectancy could be conditions generally considered to be mental health related. For example, Case and Deaton (2015) demonstrate the decreasing life expectancy for white middle-aged men is, in part, driven by increased suicide rates and substance abuse among this cohort. Several researchers have further noted the effects of Medicaid on mental health. For example, researchers used the Oregon Health Insurance Experiment to demonstrate Medicaid improves individual mental health and decreases rates of depression (Finklestein et al. 2012). Furthermore, researchers have long noted the importance of public insurance systems to the treatment of substance abuse and mental health issues (Mark et al. 2011; Levit et al. 2008; Bouchery, Harwood, Dilonardo, & Vandivort-Warren 2012). This paper seeks to explore the importance of Medicaid with respect to suicide rates across different states. Using methodology employed by Sommers (2017), I develop a difference-in-differences model to investigate the effect of the Affordable Care Act’s Medicaid expansion on suicide rates between the years 2004 and 2015. Furthermore, I use states who expanded Medicaid before the 2014 ACA expansions to examine the robustness of Medicaid expansions on suicide rates.