Three essays on the effects of the Affordable Care Act on insurance coverage, health, and cost of coverage

One of the goals of the Patient Protection Affordable Care Act was to improve access to affordable coverage by creating the HIMs, mandating coverage, and expanding Medicaid eligibility. However, federal legislative and regulatory changes have led to rising premiums, insurer exit, and disenrollment from the health insurance marketplaces (HIM). Public health and economic crises during the pandemic may have reversed the health gains through Medicaid expansion. In this dissertation, I empirically examine factors that may have contributed to declining enrollment, health, and affordability of coverage. Specifically, in the first study, I employ a difference-differences and synthetic control methods model to examine the effect of the state-based individual mandate on insurance coverage and enrollment. In the second study, I assess the protective effects of the Medicaid expansion on adverse mental health during the pandemic using a difference-in-differences model. In the third paper, I use a difference-in-differences and synthetic control method to examine the effect of the section 1332 reinsurance program on premiums and insurer participation.