This paper examines the impacts of the Affordable Care Act (ACA) – which substantially increased insurance coverage through regulations, mandates, subsidies, and Medicaid expansions – on behaviors related to future health risks after three years. Using data from the Behavioral Risk Factor Surveillance System and an identification strategy that leverages variation in pre-ACA uninsured rates and state Medicaid expansion decisions, we show that the ACA increased preventive care utilization along several dimensions, but also increased risky drinking. These results are driven by the private portions of the law, as opposed to the Medicaid expansion. We also conduct subsample analyses by income and age.

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In 2005 and 2009, Elizabeth Warren and her co-authors released two papers claiming that more than 50 percent of all bankruptcy filings in the U.S. were caused by medical debts. I wrote about the problems with these studies when they first came out, and even testified in Congress against reading too much into the findings of these studies because they suffered from several biases. Now an academic study published in the New England Journal of Medicine is skeptical of these results as well. The study tracks a stratified sample of adults between the ages of 25 and 64 who were admitted to the hospital for non-birth-related reasons between 2003 and 2007. It finds that fewer than 4 percent of hospitalizations resulted in bankruptcies, far lower than the 2009 study’s claimed 62 percent.

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