The Institutional Determinants of Health Insurance: Moving Away From Labor Market, Marriage, and Family Attachments Under the ACA

Carmen Gutierrez , University of Texas at Austin

Recent changes to the provision of health care provides a unique opportunity to examine the effects of policy reform on the historically constructed categories linking working-age Americans to health insurance. Taking advantage of this fundamental shift in the country’s system of public social provision, I use data from the National Survey on Drug Use and Health (NSDUH) to explore patterns of health insurance coverage from before and after the ACA became active in 2014. The results show that the salience of labor market, marriage, and family attachments as pathways to coverage significantly declined in the first three years following the passage of the ACA. By providing adults with a new route to coverage decoupled from their institutional attachments, the ACA helped to narrow health insurance inequalities across gender, race and ethnicity, and education.

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 Presented in Session 196. Policies, Programs and Their Impacts on Health and Mortality