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The Impact of the Affordable Care Act in Puerto Rico

  • Aaron M. Gamino ORCID logo EMAIL logo
Published/Copyright: May 17, 2024
The B.E. Journal of Economic Analysis & Policy
From the journal The B.E. Journal of Economic Analysis & Policy Volume 24 Issue 3

Abstract

Was the Affordable Care Act (ACA) effective in the U.S. territories? This paper explores this question by examining the impact of the ACA’s dependent mandate and Medicaid expansion in Puerto Rico. The dependent mandate led to a 4.3 percentage point increase in health insurance coverage for Puerto Rican young adults due to increased employer-sponsored insurance coverage, and the Medicaid Expansion increased Medicaid coverage by 2.4 percentage points. The impact of both policies in Puerto Rico is smaller than in the mainland, highlighting the importance of considering how federal legislation affects territories with economic and health environments dissimilar to the mainland.

Keywords: Affordable Care Act; insurance; territories; Puerto Rico; Medicaid; employer sponsored insurance
JEL Classification: I13; I18; I38
Corresponding author: Aaron M. Gamino, Department of Economics and Finance, 5235 Middle Tennessee State University , MTSU Box 27, 37132-0002, Murfreesboro, TN, USA, E-mail:

  1. Competing interests: The author has no sources of funding or conflicts of interest to disclose.

Appendix A: Supplementary Figures and Tables

Table A1:

Effects of the ACA dependent mandate, 2008 to 2013.

Employed Full time Self-employed Income from wages Total income
(1) (2) (3) (4) (5)
Panel A: Puerto Rico
0.006 −0.005 −0.010a 202.92 277.68
(0.009) (0.015) (0.005) (292.91) (273.77)
Wild bootstrap p-value 0.257 0.775 0.074 0.541 0.365
N = 18,465

  1. The data come from the 2008–2013 IPUMS American Community Survey and Puerto Rico Community Survey. Income from wages and total income are measures in 1999 USD. The reported results are obtained by estimating Equation (1). All estimates use survey-provided weights. Standard errors clustered by age are presented in parentheses. P-values from 1000 iterations of the wild bootstrap procedure are presented. a, b, and cDenote significance at the 1, 5, and 10 % levels using the standard errors clustered by age.

Table A2:

Effects of the ACA dependent mandate, 2008 to 2013.

Married Divorced College student Undergraduate student Graduate student
(1) (2) (3) (4) (5)
Panel A: Puerto Rico
0.005 0.009 0.010 0.000 0.010
(0.005) (0.005) (0.010) (0.010) (0.005)
Wild bootstrap p-value 0.523 0.314 0.388 0.986 0.103
N = 18,465

  1. The data come from the 2008–2013 IPUMS American Community Survey and Puerto Rico Community Survey. The reported results are obtained by estimating Equation (1). All estimates use survey-provided weights. Standard errors clustered by age are presented in parentheses. P-values from 1000 iterations of the wild bootstrap procedure are presented. a, b, and cDenote significance at the 1, 5, and 10 % levels using the standard errors clustered by age.

Table A3:

Descriptive statistics for 26–64-year-olds, Mainland Hispanic.

Pre Post
Mean Std. dev. Min Max Mean Std. dev. Min Max
Unemployed 0.062 0.027 0 0.181 0.040 0.035 0 0.505
White 0.685 0.129 0.198 0.946 0.700 0.145 0.107 0.971
HS or less 0.614 0.145 0.092 0.893 0.602 0.160 0.011 0.913
Uninsured and below poverty level 0.241 0.105 0 0.574 0.201 0.109 0 0.621
Insured 0.536 0.143 0.113 0.873 0.609 0.151 0.135 0.998
Medicaid 0.074 0.055 0 0.450 0.085 0.060 0 0.549
N = 315

  1. The data come from the 2008–2013 IPUMS American Community Survey. All estimates use survey-provided weights.

Table A4:

Descriptive statistics for 26–64-year-olds, Puerto Rico <138 poverty.

Pre Post
Mean Std. dev. Min Max Mean Std. dev. Min Max
Unemployed 0.142 0.029 0.086 0.185 0.135 0.025 0.082 0.162
White 0.667 0.158 0.534 0.949 0.616 0.115 0.432 0.744
HS or less 0.624 0.052 0.530 0.676 0.591 0.048 0.510 0.650
Uninsured and below poverty level 0.094 0.037 0.064 0.159 0.076 0.034 0.046 0.135
Insured 0.843 0.066 0.730 0.906 0.870 0.056 0.765 0.925
Medicaid 0.571 0.098 0.410 0.666 0.626 0.119 0.381 0.725
N = 7

  1. The data come from the 2008–2013 IPUMS Puerto Rico Community Survey. All estimates use survey-provided weights.

Table A5:

Descriptive statistics for 26–64-year-olds, Mainland <138 poverty.

Pre Post
Mean Std. dev. Min Max Mean Std. dev. Min Max
Unemployed 0.124 0.034 0.043 0.203 0.086 0.026 0.016 0.181
White 0.683 0.183 0.084 0.978 0.678 0.181 0.073 0.980
HS or less 0.614 0.097 0.213 0.799 0.600 0.100 0.123 0.831
Uninsured and below poverty level 0.463 0.097 0.140 0.732 0.375 0.102 0.110 0.690
Insured 0.537 0.097 0.268 0.860 0.625 0.102 0.310 0.890
Medicaid 0.262 0.098 0.067 0.714 0.297 0.104 0.060 0.645
N = 315

  1. The data come from the 2008–2013 IPUMS American Community Survey. All estimates use survey-provided weights.

Table A6:

Effects of the Medicaid expansion in Puerto Rico, 2008–2016.

Married Divorced
(1) (2)
−0.014a 0.013
(0.008) (0.011)

  1. The data come from the 2008–2016 IPUMS American Community Survey and Puerto Rico Community Survey. Results are obtained using the SDiD procedure corresponding to Equation (3). Bootstrapped standard errors clustered are presented in parentheses. a, b, and c denote significance at the 1, 5, and 10 % levels.

Figure A1: Effects of the Medicaid expansion in 2015 adopting states, 2008–2016. (A) U.S. versus synthetic control. (B) U.S. versus synthetic control, Hispanic. (C) U.S. versus Synthetic control, <138 poverty. (D) U.S. versus synthetic control, Hispanic and <138 poverty. The data come from the 2008–2016 IPUMS American Community Survey. Medicaid coverage trends for the treatment and control groups. Graphs are produced using SDiD.
Figure A1:

Effects of the Medicaid expansion in 2015 adopting states, 2008–2016. (A) U.S. versus synthetic control. (B) U.S. versus synthetic control, Hispanic. (C) U.S. versus Synthetic control, <138 poverty. (D) U.S. versus synthetic control, Hispanic and <138 poverty. The data come from the 2008–2016 IPUMS American Community Survey. Medicaid coverage trends for the treatment and control groups. Graphs are produced using SDiD.

Figure A2: Effects of the Medicaid expansion in 2016 adopting states, 2008–2016. (A) U.S. versus synthetic control. (B) U.S. versus synthetic control, Hispanic. (C) U.S. versus synthetic control, <138 poverty. (D) U.S. versus synthetic control, Hispanic and <138 poverty. The data come from the 2008–2016 IPUMS American Community Survey. Medicaid coverage trends for the treatment and control groups. Graphs are produced using SDiD.
Figure A2:

Effects of the Medicaid expansion in 2016 adopting states, 2008–2016. (A) U.S. versus synthetic control. (B) U.S. versus synthetic control, Hispanic. (C) U.S. versus synthetic control, <138 poverty. (D) U.S. versus synthetic control, Hispanic and <138 poverty. The data come from the 2008–2016 IPUMS American Community Survey. Medicaid coverage trends for the treatment and control groups. Graphs are produced using SDiD.

Figure A3: Effects of the Medicaid expansion in Puerto Rico on marital status, 2008–2016. (A) Married, Puerto Rico versus synthetic control. (B) Divorced, Puerto Rico versus synthetic control. The data come from the 2008–2016 IPUMS American Community Survey and Puerto Rico Community Survey. Each subfigure presents the trends for the treatment and control groups. Graphs are produced using SDiD.
Figure A3:

Effects of the Medicaid expansion in Puerto Rico on marital status, 2008–2016. (A) Married, Puerto Rico versus synthetic control. (B) Divorced, Puerto Rico versus synthetic control. The data come from the 2008–2016 IPUMS American Community Survey and Puerto Rico Community Survey. Each subfigure presents the trends for the treatment and control groups. Graphs are produced using SDiD.

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Received: 2023-11-03
Accepted: 2024-04-26
Published Online: 2024-05-17

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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  2. Research Articles
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https://doi.org/10.1515/bejeap-2023-0368
Keywords for this article
Affordable Care Act; insurance; territories; Puerto Rico; Medicaid; employer sponsored insurance

Articles in the same Issue

  1. Frontmatter
  2. Research Articles
  3. Asymmetric Performance Evaluation Under Quantity and Price Competition with Managerial Delegation
  4. Incentive-Induced Social Tie and Subsequent Altruism and Cooperation
  5. University Admission: Is Achievement a Sufficient Criterion?
  6. Taxing Firearms Like Alcohol or Tobacco
  7. The Growing Importance of Social Skills for Labor Market Outcomes Across Education Groups
  8. The Impact of the Affordable Care Act in Puerto Rico
  9. Strategic Individual Behaviors and the Efficient Vaccination Subsidy
  10. Is Family-Priority Rule the Right Path? An Experimental Study of the Chinese Organ Allocation System
  11. Letters
  12. Real-effort in the Multilevel Public Goods Game
  13. Initial Payment and Refunding Scheme for Climate Change Mitigation and Technological Development Among Heterogeneous Countries
  14. Edutainment and Dwelling-Related Assets in Poor Rural Areas of Peru
  15. Biased Voluntary Nutri-Score Labeling
  16. Decompositions of Inequality and Poverty by Income Source
  17. Job Loss and Migration: Do Family Connections Matter?
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