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The Indirect Benefits of Medicaid Expansion

SPA professors explore the effects of Medicaid expansion on household tasks and childcare.

Much research has established the positive health outcomes related to Medicaid expansion under the Affordable Care Act (ACA), but SPA Professors Aparna Soni and Taryn Morrissey are exploring its effects on other markers of wellness – and finding benefits.

In the December 2021 issue of Southern Economic Journal, the two published “The Effects of Medicaid Expansion on Home Production and Childcare,” which examines how Medicaid expansion changes time spent on home production (or household tasks) and childcare. Using time-diary data from the American Time Use Survey (ATUS), published each year by the Bureau of Labor Statistics, they compared the time use patterns of individuals in states that expanded Medicaid versus non-expansion states, before and after implementation.

“If you want to understand how Americans spend their day, the ATUS is one of the best, most comprehensive sources out there,” said Soni. “We used the ATUS data to calculate the amount of time each respondent spent each day on food preparation, housework, home and vehicle maintenance, lawn and garden, pet care, household management, enrichment activities with children, children’s education activities, and caring for children as a primary activity.”

“Despite all of us having a time “budget” constraint of 24 hours and time being a non-renewable resource, relatively little is known about how public policies and programs affect how we allocate time,” added Morrissey.

They found that Medicaid expansion increased the amount of time low-income adults spent on home production by 12 minutes per day (9.5%) and on childcare by 6.6 minutes per day (7.7%).

Public health insurance programs like Medicaid provide in-kind resources that may improve health and reduce stress, altering time use patterns, explained Soni.

“Insurance increases household resources, reduces psychological distress, and increases mental bandwidth – these are all potential mechanisms through which the Medicaid expansions may have increased time spent on home production and childcare,” she said. “Also, through increased contact with primary care providers, some newly insured individuals might receive medical advice that encourages cooking at home, engaging in enrichment activities with children, and other healthy lifestyle choices.”

The authors recommend that policymakers in states considering Medicaid expansion factor in both direct health outcomes and these indirect lifestyle benefits.

“The home production and childcare [time-use] outcomes we examined are typically unpaid, but can have huge benefits for public health,” Soni continued. “For example, we found that Medicaid expansion led to increases in the amount of time low-income people spent on food preparation. Considering that food prepared at home has fewer total calories and less total fat, saturated fat, and cholesterol per calories, this is a trend in the right direction.”

Medicaid expansion also increases the time low-income people spend with their children; parent-child bonding time offers significant benefits for both parents and children’s health and well-being and children’s educational outcomes.

“Overall, our findings suggest that there are overlooked benefits from expansions in public health insurance,” said Soni. “These results are especially relevant in the context of COVID and its associated economic downturn, as Medicaid enrollment increased dramatically and as more states consider expanding their Medicaid programs.”

The authors see several opportunities for future research on the subject, to better understand the mechanism(s) behind time use changes related to Medicaid expansion and to check for similar time-use effects of other public benefits, such as the Supplemental Nutrition Assistance Program (SNAP), paid family leave, and the Earned Income Tax Credit (ETIC).