ECONOMIC REPORT OF THE PRESIDENT

for confidence that expanded insurance coverage will translate into better
health. The Oregon Health Insurance Experiment documented significant
improvements in self-reported health status and mental health due to
expanded Medicaid coverage (Finkelstein et al. 2012; Baicker et al. 2013).
Studies of Massachusetts health reform concluded that the coverage expansion
drove improvements in self-reported physical and mental health, as
well as reductions in mortality (Van der Wees, Zaslavsky, and Ayanian 2013;
Sommers, Long, and Baicker 2014), and a study of state Medicaid expansions
targeting low-income adults during the early 2000s reached similar
conclusions (Sommers, Baicker, and Epstein 2012). Studies of prior expansions
of Medicaid and CHIP coverage targeting low- and moderate-income
children have documented that health benefits of expanded coverage can be
long-lasting, with adults who had access to coverage in childhood experiencing
lower risk of death and hospitalization many years later (Wherry et al.,
2015; Brown, Kowalski, and Lurie 2015; Wherry and Meyer 2016).
Early evidence on the effects of the ACA appears quite consistent
with the results documented for earlier coverage expansions. Barbaresco,
Courtemanche, and Qi (2015) report improvements in self-reported health
status among young adults following implementation of the ACA’s provision
allowing young adults to remain on a parent’s plan. Looking at the main
ACA coverage provisions that took effect in 2014, Sommers et al. (2015) find
that the share of non-elderly adults reporting that they are in fair or poor
health has fallen as coverage has expanded, as has the percentage of days
that respondents report having their activities limited by health problems.
Research has also found evidence that gains in self-reported health status
have been larger in states that have expanded their Medicaid programs
(Sommers et al. 2016; Simon, Soni, and Cawley 2016).
While direct estimates of the law’s effects on physical health outcomes
are not yet available, largely because these data become available with longer
lags, these effects are likely to be quite important. Consider, for example, one
particularly important health outcome: mortality. As discussed in detail in
CEA (2015), there is considerable evidence that prior coverage expansions
targeting populations similar to those targeted in the ACA generated substantial
reductions in mortality rates. The most relevant existing estimate of
the effect of insurance coverage on mortality comes from work by Sommers,
Long, and Baicker (2014) on Massachusetts health reform. By comparing
experiences in Massachusetts to those in neighboring states, they estimate
that one death was avoided annually for every 830 people who gained health
insurance. In conjunction with the estimate cited earlier in this chapter that
20 million adult have gained coverage because of the ACA as of early 2016,
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