JSIT20-04: The Effect of Insurance Expansion on SSI Participation: Evidence from the ACA

Abstract

Before states expanded their Medicaid programs, low-income adults without dependent children were typically only eligible for Medicaid insurance coverage through the Supplemental Security Income Program (SSI) due to a disability. The expansion of Medicaid eligibility due to the Affordable Care Act (ACA) provides an opportunity for low-income childless adults to obtain health insurance coverage without having to complete an intensive SSI application process and thus removes the need to satisfy the SSI asset and disability criteria. Previous research has established that pre-ACA Medicaid expansions and very short-term ACA Medicaid expansions reduced SSI participation among nonelderly childless adults. Further, there is evidence that there are disparities in the coverage gains from the ACA Medicaid expansions by demographic groups, with gains largest among young adults, non-whites, and unmarried individuals. Given these disparities and insurance coverage barriers to transitioning from pediatric to adult healthcare, this study examines the long-term impact of the ACA Medicaid expansions on SSI participation among low-income childless young adults and the Medicaid expansions-SSI relationship across different demographic groups. To estimate these relationships, I use survey data on SSI benefits from the American Community Survey (ACS) in a two-way fixed-effects model to uncover the causal effects of ACA Medicaid expansions on SSI participation. These findings suggest that Medicaid expansions reduced SSI participation by nine percent among young adults, with reductions primarily among unmarried individuals. However, there is no statistically significant evidence that the impact of ACA Medicaid expansions on SSI participation differs by race/ethnicity, gender, and educational attainment.