The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis

Avtar, Ruchi; Chakrabarti, Rajashri; Meyerson, Lindsay; Nober, William; Pinkovskiy, Maxim L.

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The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis

Abstract: Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that (1) health insurance changes discontinuously at the frontier, (2) COVID-19 testing is discontinuously larger in Medicaid-expanding states, and (3) the fraction of beds occupied in ICUs is discontinuously smaller in Medicaid-expanding states. We also find that (4) COVID- 19 cases and deaths do not change discontinuously at the frontier, with the precision of these estimates being low, but the null result on deaths being general across demographic groups. Finally, we find that (5) smart thermometer readings of fever rates from Kinsa, Inc. do not change discontinuously at the Medicaid expansion frontier.

Keywords: Affordable Care Act; COVID-19; Medicaid; regression discontinuity;

JEL Classification: C21; I13; I18;