Insurance Coverage Expansion for Children in Low-Income Households Demonstrates Added Benefits

According to recent study findings, the academic achievements of children in low-income households in Iowa were improved by the Affordable Care Act’s (ACA) insurance coverage expansions such as establishing Marketplaces and increasing Medicaid eligibility for adults.

George L Wehby, PhD, University of Iowa, Iowa City, IA, and National Bureau of Economic Research, Cambridge, MA, conducted a difference-in-differences model to examine the association between insurance coverage status before and after Medicaid expansion for children.

“Using unique data on school tests merged with birth certificates for children in Iowa and taking advantage of area-level variation in uninsurance rates before the expansions, this study showed that the ACA insurance expansions were associated with improved children’s test scores on reading in households of mothers with a high school education or less,” said Dr Wehby. “The effect was observed in the third and fourth years after the expansion and not immediately after.”

The study period spanned from 2011-2018. The average maternal age at testing was 37.1 years and the average child’s age was 12.2 years.

“A total of 29% of mothers had less than a high school education (at child’s birth) compared with 71% who had a high school education,” found Dr Wehby. “A total of 52.8 % of mothers were married, 8.8 % were non-White, and 11% were Hispanic.”

While children’s reading test scores improved, researchers discussed that there was no consistent evidence for effects on math and that more research is needed to understand possible differences in effects.

“Although it is not exactly clear why there would be improvement in reading but not math in this context, one speculation might be that changes in reading skills among school-age children are particularly sensitive to household changes and parental engagement, whereas changes in math skills at that age are more influenced by school effects,” said Dr Wehby.

Furthermore, Dr Wehby discussed that while the study had strengths including population-level linkage of birth certificates and school tests, it was not without limitations. Other school performance indicators like student behavioral outcomes and high school graduation were not measured.

“This study provides novel evidence that the ACA insurance coverage expansions improved the academic achievement of children in low-income households in Iowa,” he concluded. “The findings point to broader spillover benefits from widespread insurance coverage gains, particularly for low-income households.”

Reference:
Wehby GL. The impact of household health insurance coverage gains on children’s achievement in Iowa: evidence from the ACA. Health Aff (Millwood). 2022;41(1). doi:10.1377/hlthaff.2021.01222