How Workers Fared under the ACA

Journal of Health Politics, Policy, and Law, 2020

Posted: 13 Aug 2020

Date Written: June 19, 2020


Many politicians, policy makers, and analysts have debated whether the Affordable Care Act (ACA) would have negative effects on the labor market, such as reducing employment, earnings, or hours worked. Building on the existing literature, we investigated how workers’ coverage changed under the ACA and whether coverage gains were associated with changes in labor market outcomes across occupations through 2017.We also examined whether occupations experiencing increased coverage through non-employment sources (i.e., Medicaid or individual plans purchased on the ACA’s Marketplaces) also experienced offsetting declines in employer-sponsored insurance (ESI) coverage. Finally, we investigated whether the employer mandate was associated with changes in ESI offers to workers. Among workers in occupations experiencing larger coverage gains under the ACA, we found no evidence that employment, hours worked, or earnings fell relative to workers in occupations that had little change in coverage rates over the same period. Moreover, ESI offers remained stable, even among workers in firms likely subject to the employer mandate. Overall, we found that predictions that the coverage provisions and mandates of the ACA would lead to adverse labor market effects did not materialize.

Keywords: ACA, Affordable Care Act, Employment, Part-Time, Labor Supply, Labor Demand, Health Insurance, ESI, Earnings

JEL Classification: I10, I11, J01, J08, J20

Suggested Citation

Gangopadhyaya, Anuj and Garrett, A. Bowen, How Workers Fared under the ACA (June 19, 2020). Journal of Health Politics, Policy, and Law, 2020, Available at SSRN:

Anuj Gangopadhyaya

Urban Institute ( email )

2100 M Street, NW
Washington, DC 20037
United States

A. Bowen Garrett (Contact Author)

Urban Institute ( email )

500 L'Enfant Plaza SW
Washington, DC 20024
United States


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