Health Insurance Coverage Changes Under the Affordable Care Act Among High Housing Cost Households, 2010–18

This study examines the impact of the Affordable Care Act (ACA) on health insurance coverage among rent-burdened households-those spending more than 30% of their income on rent-and non-rent-burdened households. Using data from American Community Survey, we find that Medicaid take-up rate increased 8.88 percentage points (pp) among rent-burdened households and 7.54 pp among non-rent-burdened households in expansion states. Conditional on household income and demographic characteristics, rent-burdened households exhibit a 1.5 pp higher likelihood of Medicaid enrollment, with an additional decline of 0.7 pp in employer-sponsored insurance and 1.0 pp in directly purchased insurance enrollment. These effects were more pronounced among individuals aged over 26 and those in states without state-run exchanges. The findings show the importance of tailored Medicaid policies to assist households facing housing burdens, especially for those ineligible for housing vouchers.