THREE ESSAYS IN HEALTH SERVICES RESEARCH: IMPACT OF THE AFFORDABLE CARE ACT ON ACCESS TO CARE AND HOSPITALIZATION IN TEXAS

Abstract

This dissertation presents evaluations of ACA reforms in the state of Texas. In the first essay, I use descriptive analysis to show that after the establishment of the ACA Marketplaces in Texas, the rate of hospital discharges decreased for uninsured patients and increased for privately insured patients. In the second essay, I use the difference-in-difference method to examine if the Marketplace component of the ACA has affected the uninsured discharge rate for acute care services. I find a causal impact of Marketplaces on the ratio of uninsured discharges. In the third essay, I examine the expansion of Medicaid Managed Care (MMC) that required almost all beneficiaries to shift from Medicaid Fee-for-Service to MMC. I examine if this reform has reduced the volume of discharges overall and for potentially preventable conditions in acute care hospitals. I find no impact of MMC on inpatient care use over the time span of study.