Staff Reports
The Affordable Care Act and the COVID-19 Pandemic: A Regression Discontinuity Analysis
Number 948
November 2020 December 2022

JEL classification: C21, I13, I18

Authors: Ruchi Avtar, Rajashri Chakrabarti, Lindsay Meyerson, William Nober, and Maxim L. Pinkovskiy

Did Medicaid expansion under the Affordable Care Act affect the course of the COVID-19 pandemic? We answer this question using a regression discontinuity design for counties near the borders of states that expanded Medicaid with states that did not. Relevant covariates change continuously across the Medicaid expansion frontier. We find that (1) health insurance changes discontinuously at the frontier, (2) COVID-19 testing is discontinuously larger in Medicaid-expanding states, and (3) the fraction of beds occupied in ICUs is discontinuously smaller in Medicaid-expanding states. We also find that (4) COVID- 19 cases and deaths do not change discontinuously at the frontier, with the precision of these estimates being low, but the null result on deaths being general across demographic groups. Finally, we find that (5) smart thermometer readings of fever rates from Kinsa, Inc. do not change discontinuously at the Medicaid expansion frontier.

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Author Disclosure Statement(s)
Rajashri Chakrabarti
This paper uses data from Kinsa, Inc. Prior to circulation, this paper was vetted by Kinsa, Inc. to ensure that published statistics complied with the confidentiality policies of Kinsa, Inc. and did not reveal proprietary Kinsa information. Kinsa did not vet the content of the paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://www.newyorkfed.org/research/staff_reports/index.html. The author declares that she has no further relevant or material financial interests that relate to the research described in this paper.

Lindsay Meyerson
This paper uses data from Kinsa, Inc. Prior to circulation, this paper was vetted by Kinsa, Inc. to ensure that published statistics complied with the confidentiality policies of Kinsa, Inc. and did not reveal proprietary Kinsa information. Kinsa did not vet the content of the paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://www.newyorkfed.org/research/staff_reports/index.html. The author declares that she has no further relevant or material financial interests that relate to the research described in this paper.

William Nober
This paper uses data from Kinsa, Inc. Prior to circulation, this paper was vetted by Kinsa, Inc. to ensure that published statistics complied with the confidentiality policies of Kinsa, Inc. and did not reveal proprietary Kinsa information. Kinsa did not vet the content of the paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://www.newyorkfed.org/research/staff_reports/index.html. The author declares that he has no further relevant or material financial interests that relate to the research described in this paper.

Maxim Pinkovskiy
This paper uses data from Kinsa, Inc. Prior to circulation, this paper was vetted by Kinsa, Inc. to ensure that published statistics complied with the confidentiality policies of Kinsa, Inc. and did not reveal proprietary Kinsa information. Kinsa did not vet the content of the paper. Prior to circulation, this paper was reviewed in accordance with the Federal Reserve Bank of New York review policy, available at https://www.newyorkfed.org/research/staff_reports/index.html. The author declares that he has no further relevant or material financial interests that relate to the research described in this paper.
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