THE IMPACT OF MEDICAID EXPANSION ON TOBACCO USE: A STAGGERED DIFFERENCE-IN-DIFFERENCE ANALYSIS USING BRFSS DATA

This study examines the impact of Medicaid expansion under the Affordable Care Act (ACA) on tobacco use among U.S. adults, using Behavioral Risk Factor Surveillance System (BRFSS) data from pre- and post-ACA years. A staggered difference-in-differences approach is applied to capture variation in expansion timing across states, with survey weights incorporated to produce nationally representative estimates. Tobacco use is measured for both daily users and social or intermittent users, across all product types including e-cigarettes. Results indicate that Medicaid expansion had no statistically significant effect on smoking patterns among users, suggesting that behaviors remained relatively constant as tobacco products evolved during the ACA expansion period. These findings underscore the importance of understanding patterns of tobacco use when evaluating public health policy and suggest that targeted interventions and legislation may be needed to effectively reach tobacco users.