Publication Date



Damien Sheehan-Connor


Economics (ECON)


English (United States)


This thesis considers the important question of whether the Patient Protection and Affordable Care Act (ACA) increased access to health care or improved health outcomes more broadly. It specifically examines the response of child vaccination rates to the Medicaid expansions under the ACA. The advantage of studying child vaccination rates is that they are a measure of health care access that is tightly linked to child health outcomes over the longer run and would be expected to respond to the ACA fairly quickly. The thesis uses difference-in-difference regressions to look for the effects of the Medicaid expansions on people’s behavior, both in terms of insurance enrollment and in terms of utilizing access to health care. The estimator is implemented by comparing people in states that expanded Medicaid with those that did not. The results provide evidence that although insurance coverage of children increased with the ACA, it probably was not the direct result of the Medicaid expansions. However, I find evidence that the Medicaid expansions were associated with an increase in vaccination rates, which likely occurred through behavioral changes such as peer effects or the agglomeration effect.



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