A Review of the Evidence Suggests Targeted Programs Represent Better Policy
by Brian Blase, Ph.D., and David Balat
• The ACA significantly expanded
insurance coverage between 2013
and 2017, but Americans’ health
worsened during this period as life
expectancy declined for three consecutive years from 2014 to 2017.
• States that did not adopt Medicaid
expansion had favorable mortality
trends from 2013 to 2017 compared
with states that adopted the expansion, in part because they had fewer
people die from opioid overdoses.
• Medicaid expansion was associated
with improvements in self-reported
health and greater financial peace
of mind, with mixed evidence on
physical health benefits. It was associated with a decline in mortality for
those near retirement age.
• The bulk of the evidence suggests
that targeted health programs,
including those geared toward children, prove to be far better public
investments than does a massive
• Large coverage expansions disappoint for several reasons: the uninsured receive nearly 80 percent as
much care as similar insured people,
the crowd-out of private coverage,
and indirect effects on others such
as longer wait times for care.