Abstract: Health Insurance and Housing Stability: The Effect of Medicaid Expansion on Evictions (Society for Social Work and Research 23rd Annual Conference - Ending Gender Based, Family and Community Violence)

Health Insurance and Housing Stability: The Effect of Medicaid Expansion on Evictions

Saturday, January 19, 2019: 8:00 AM
Golden Gate 7, Lobby Level (Hilton San Francisco)
* noted as presenting author
Heidi Allen, PhD, Associate Professor, Columbia University, New York, NY
Tal Gross, PhD, Assistant Professor, Boston University, MA
Naomi Zewde, PhD, Postdoctoral Scholar, Columbia University, New York, NY
Objective: Evictions occur when a dispute between a tenant and a landlord result in the tenant being removed from their home. The phenomenon is under-studied, and it is unclear what factors cause tenants to fall behind on their rent and end up being evicted. One possibility is that out-of-pocket medical costs may contribute to some evictions and so, in that case, expansions of public health insurance coverage could lead to a reduction in the number of evictions. To test that hypothesis, we study California's early expansion of Medicaid under the Affordable Care Act. 

Data Sources: We utilize a commercial evictions database, provided to the study authors for the purposes of research, that includes all evictions in fifteen states (WI, WA, UT, PA, OR, OH, NV, NJ, MA, HI, FL, DE, CT, AZ, and CA) from January 2009 through December 2013 (roughly 24 months before and twenty-four months after the 2011-2012 California Medicaid expansion). 

Study Design: We compare evictions rates (counts and per-capita) in California Medicaid expansion counties with comparison counties in the 14 states that had not (yet) expanded Medicaid during the timeframe of the study. We run standard difference-in-difference regressions and also employ a synthetic-control approach in order to estimate the number of evictions California counties would have experienced in the absence of the Medicaid expansion. We additionally employ a number of strategies to test the validity of our empirical approach. 

Principal Findings: The results suggest 60 fewer evictions per county month after Medicaid expansion, from a previous mean of 177 per county-month. Using back-of-the-envelope calculations with the number of Californians who gained coverage by county, we estimate that for every new enrollee, there were 0.009 fewer evictions per year.

Implication for Policy: Evictions are costly for landlords and detrimental to the wellbeing of low-income families. This study contributes to a growing body of literature that suggest one of the principal benefits of Medicaid expansion for low-income adults relates to protection from catastrophic medical debt and improved financial stability.