The affordable care act and ambulance response times

J Health Econ. 2019 Sep:67:102213. doi: 10.1016/j.jhealeco.2019.05.010. Epub 2019 Jul 9.


This study contributes to the literature on the capacity challenges faced by health care providers after insurance expansions by examining the Affordable Care Act (ACA) and ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 24%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.

Keywords: Affordable care act; Ambulance; Health care capacity; Health care workforce; Health insurance.

MeSH terms

  • Ambulances / statistics & numerical data*
  • Humans
  • Insurance Coverage / legislation & jurisprudence
  • Insurance Coverage / statistics & numerical data
  • Medicaid / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Patient Protection and Affordable Care Act*
  • Surge Capacity
  • Time Factors
  • United States