Healthcare and Hunger: Impacts of the Affordable Care Act on Food Insecurity in America

This paper describes how the Medicaid expansions associated with the Patient Protection and Affordable Care Act of 2010 influenced the ability of households to purchase adequate food. This paper also closely examines the role of the Supplemental Nutrition Assistance Program in meeting food needs, and whether multiple program participation affects food insecurity outcomes

ESSAYS ON TRANSFER-PROGRAM INTERACTIONS AMONG LOW-INCOME HOUSEHOLDS

This dissertation consists of three essays examining the role of transfer-program interactions for families and households who participate in the social safety net. The safety net is comprised of many different programs, run by different agencies, governed by different rules, and often administered by disparate and secluded entities. However, many households participate in multiple programs, subjecting them to the milieu of administrative hurdles. In this dissertation, I try to untangle some of the intended and unintended effects of program participation that may be experienced by these households. In Essay 1, I examine the effect of the Patient Protection and Affordable Care Act of 2010 (ACA) on food hardship in US households, utilizing food security information from the Food Security Supplement of the Current Population Survey. Because states adopted the Medicaid expansions provided under the ACA at different times beginning in 2014, the cross-state, over time variation allows me to separate the impact of the ACA on food hardship using triple difference specifications. The richness of questions in the Food Security Supplement allows me to examine the effect of the ACA across different measures of food hardship, and also examine differential response for households participating in the Supplemental Nutrition Assistance Program (SNAP). Examining the mechanisms through which the ACA could affect food insecurity, I find the ACA not only increased average weekly food expenditure, but also the probability a household participates in SNAP. I employ a two-stage, control function approach to address reverse causality between SNAP and food insecurity. I find that the ACA reduced the probability that a household participating in SNAP falls into the two lowest food security categories by 6.5 percentage points and reduced the probability of being food insecure by 14.2 percentage points. Across specifications, I find strong evidence for increasing returns to program participation, and evidence of a differential impact of the ACA across the distribution of food hardship. In Essay 2, I examine how grant funding and fiscal structure affect program response over the business cycle. I compare child enrollment in Medicaid, a matching grant funding program, with enrollment the State Children\u27s Health Insurance Program, a block grant funded program, utilizing the similarities in beneficiaries, program benefits, and administration to isolate the impact of fiscal structure. I utilize administrative enrollment records, along with individual level participation data, and find a one percentage point increase in the unemployment rate leads to a 7.6% decrease in the number of beneficiaries per person enrolled in block grant funded programs, and a 10% decrease in state expenditure per person decreases the probability of enrollment in a block grant program by 0.58 percentage points. I also find that enrollment is much more persistent among matching grant funded programs, and being enrolled in a block grant funded program the previous period increases the probability of enrolling in a matching grant program this period 75% more than remaining enrolled in the block grant funded program. Finally, in Essay 3 I explore the effect of the minimum wage on the self-reported value of public assistance program benefits, and the joint effect of the minimum wage and public assistance programs on the income to poverty ratio using data from the 1995-2016 Current Population Survey Annual Social and Economic Supplement. In the first stage, I estimate a Tobit model controlling for the censoring of received benefits from below at zero, and examine the effect of changes in the minimum wage on the self-reported dollar value of benefits received for food stamps/the Supplemental Nutrition Assistance Program (SNAP), Aid to Families with Dependent Children (AFDC)/Temporary Assistance to Needy Families (TANF), Supplemental Security Income (SSI), and the Earned Income Tax Credit (EITC), as well as the total sum of benefits. I find that the minimum wage reduces the value of means-tested benefits, but that this effect is strongest for programs with strong work requirements. Utilizing the residuals from the first stage, I employ a control function approach to estimate the joint effect of the minimum wage and program benefits on the income to poverty ratio. I find the own-effect of the minimum wage provides a small increase in the income to poverty ratio, but that the total effect, accounting for changes in benefits, attenuates by approximately 30%