Disability Heterogeneity in the Impact of the ACA’s Medicaid Expansions on Disability Employment
Objectives To test for heterogeneous treatment effects in the impact of the Affordable Care Act’s (ACA) Medicaid expansion on the employment of people with disabilities.
Methods Using difference-in-difference approaches, we estimate the impact of the ACA’s Medicaid expansion on employment outcomes for various subgroups of people with disabilities. Using the Current Population Survey (CPS) from June 2008 to December 2019, we segment the disabled population by disability type, disability recency and labor force attachment, leveraging the longitudinal aspect of the CPS.
Results Among persons with higher labor force attachment, we find that Medicaid expansion reduced the employment rate of persons with new disabilities by a statistically significant -3.2%, while there was a precisely estimated null effect for persons with ongoing disabilities. Among those with lower labor attachment, we find suggestive evidence of offsetting treatment effects among persons with new versus ongoing disabilities. Medicaid expansion increased the employment rate of persons with ongoing disabilities by 10.5% but decreased the employment rate of persons with new disabilities by -9.2%. However, these latter estimates for persons with lower labor force attachment are imprecisely estimated, limiting the conclusions that can be drawn from them.
Conclusions Existing literature on the disability employment effects of Medicaid expansion is mixed in part due to different study designs picking up different effects on distinct groups of people with disabilities. We show that accounting for disability heterogeneity allows for more precise estimates of policy impacts for some populations while providing suggestive evidence of countervailing treatment effects for others.
We thank Hailey Clark for outstanding research assistance and Marai Hayes for helpful discussions about job lock. The research reported herein was performed pursuant to grant RDR18000003 from the US Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium and grant 90RTEM0006 01 00 from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) to the Disability-Inclusive Employment Policy (DEIP) Rehabilitation Research and Training Center (RRTC). The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA, NIDILRR, any agency of the Federal Government, or NBER. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.