The Affordable Care Act Medicaid Expansions and Personal Finance

Med Care Res Rev. 2019 Oct;76(5):538-571. doi: 10.1177/1077558717725164. Epub 2017 Sep 16.


Using a novel data set from a major credit bureau, we examine the early effects of the Affordable Care Act Medicaid expansions on personal finance. We analyze less common events such as personal bankruptcy, and more common occurrences such as medical collection balances, and change in credit scores. We estimate triple-difference models that compare individual outcomes across counties that expanded Medicaid versus counties that did not, and across expansion counties that had more uninsured residents versus those with fewer. Results demonstrate financial improvements in states that expanded their Medicaid programs as measured by improved credit scores, reduced balances past due as a percent of total debt, reduced probability of a medical collection balance of $1,000 or more, reduced probability of having one or more recent medical bills go to collections, reduction in the probability of experiencing a new derogatory balance of any type, reduced probability of incurring a new derogatory balance equal to $1,000 or more, and a reduction in the probability of a new bankruptcy filing.

Keywords: Affordable Care Act; Medicaid; health; health insurance; health policy; personal finance; state policy; uninsured.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Financing, Personal / statistics & numerical data
  • Health Policy
  • Humans
  • Insurance Coverage*
  • Insurance, Health*
  • Medicaid* / economics
  • Medicaid* / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Models, Statistical
  • Patient Protection and Affordable Care Act* / economics
  • Patient Protection and Affordable Care Act* / legislation & jurisprudence
  • United States