Drawbacks and aftermath of the Affordable Care Act: ex-ante moral hazard and inequalities in health care access

https://doi.org/10.4081/jphr.2021.2135
  • Daniele Corso
    Department of Economics and Management, University of Pavia, Italy.
    https://orcid.org/0000-0002-6363-1243

ABSTRACT

Background: Following the introduction of the Affordable Care Act, various studies have tried to identify the effects of the Reform, without reaching a clear consensus. The aim of this study was to investigate whether expansion of the Medicaid program has led to less inequality in access to health care and to a higher level of ex-ante moral hazard.

Design and Methods:
 The analysis was conducted on two-year longitudinal data (2014-2015) regarding a cohort of 15,898 individuals from a Medical Expenditure Panel Survey (MEPS). After a data cleaning procedure, a sample of 9,255 individuals was selected for the inequality part of the study and 2,307 for the ex-ante moral hazard analysis. Propensity score matching with nearest-neighbour and kernel matching algorithms, difference-in-difference models and concentration index, corrected according to Erreygers methodology, were adopted.

Results:
 The analysis showed that disparities were reduced between social classes although the ex-ante moral hazard is a real problem with the Affordable Care Act since individuals covered by public insurance tended to abuse the public service. Among those who benefited from the Act, a reduction in preventive behaviours was observed: there was an increase in smoking and a decrease in level of physical activityAs far as concerns access to health care, there was a decrease in inequality in emergency visits, inability to get care and getting care when needed among beneficiaries of the Reform.

Conclusions:
This study demonstrates that the extension of Medicaid has had a dual effect of reducing disparities in access to health care but, at the same time, it seems to have induced people to take less care of themselves.

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