Medicaid Expansion Did Not Result In Significant Employment Changes or Job Reductions in 2014

Medicaid expansion undertaken through the Affordable Care Act (ACA) is already producing major changes in insurance coverage and access to care, but its potential impacts on the labor market are also important policy considerations. 

Economic theory suggests that receipt of Medicaid might benefit workers who would no longer be tied to specific jobs to receive health insurance (known as job lock), giving them more flexibility in their choice of employment, or might encourage low-income workers to reduce their hours or stop working if they no longer need employment-based insurance. Evidence on labor changes after previous Medicaid expansions is mixed. 

To view the impact of the ACA on current labor market participation, we analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005-13) and the first fifteen months of the expansion (January 2014-March 2015). Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status. 

While we cannot exclude the possibility of small changes in these outcomes, our findings rule out the large change found in one influential pre-ACA study; furthermore, they suggest that the Medicaid expansion has had limited impact on labor-market outcomes thus far.

Purchase full article at:   http://goo.gl/UViyzj

By:  Gooptu A1, Moriya AS2, Simon KI3, Sommers BD4.

• 1Angshuman Gooptu is a doctoral student in the School of Public and Environmental Affairs at Indiana University, in Bloomington.
• 2Asako S. Moriya (Asako.Moriya@ahrq.hhs.gov) is a service fellow economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, in Rockville, Maryland.
• 3Kosali I. Simon is a professor in the School of Public and Environmental Affairs at Indiana University and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts.
• 4Benjamin D. Sommers is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and in the Department of Medicine at Brigham and Women's Hospital, in Boston, Massachusetts.
• Health Aff (Millwood). 2016 Jan 1;35(1):111-8. doi: 10.1377/hlthaff.2015.0747. 

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Do Open Youth Unemployment & Youth Programs Leave the Same Mental Health Scars? - Evidence from a Swedish 27-Year Cohort Study

Background

Recent findings suggest that the mental health costs of unemployment are related to both short- and long-term mental health scars. The main policy tools for dealing with young people at risk of labor market exclusion are Active Labor Market Policy programs for youths (youth programs). There has been little research on the potential effects of participation in youth programs on mental health and even less on whether participation in such programs alleviates the long-term mental health scarring caused by unemployment. This study compares exposure to open youth unemployment and exposure to youth program participation between ages 18 and 21 in relation to adult internalized mental health immediately after the end of the exposure period at age 21 and two decades later at age 43.

Methods

The study uses a five wave Swedish 27-year prospective cohort study consisting of all graduates from compulsory school in an industrial town in Sweden initiated in 1981. Of the original 1083 participants 94.3 % of those alive were still participating at the 27-year follow up. Exposure to open unemployment and youth programs were measured between ages 18–21. Mental health, indicated through an ordinal level three item composite index of internalized mental health symptoms (IMHS), was measured pre-exposure at age 16 and post exposure at ages 21 and 42.

Ordinal regressions of internalized mental health at ages 21 and 43 were performed using the Polytomous Universal Model (PLUM). Models were controlled for pre-exposure internalized mental health as well as other available confounders.

Results

Results show strong and significant relationships between exposure to open youth unemployment and IMHS at age 21 as well as at age 43. No such significant relationship is observed for exposure to youth programs at age 21 or at age 43.

Conclusions

A considered and consistent active labor market policy directed at youths could potentially reduce the short- and long-term mental health costs of youth unemployment.

Full article at:  http://goo.gl/gmKQqx

By:  Mattias Strandh^12*, Karina Nilsson³, Madelene Nordlund³ and Anne Hammarström⁴

¹Department of Social Work, Umeå University, Umeå, SE-90187, Sweden

²Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, SE-651 88, Sweden

³Department of Sociology, Umeå University, Umeå, SE-90187, Sweden

⁴Department of Public Health and Clinical Medicine, Umeå University, Umeå, SE-90187, Sweden

 

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