Health Insurance To Die For: The Impact of the Affordable Care Act's Medicaid Expansion on Criminal Homicide Rates

Abstract

While a significant body of research details the effects of Medicaid Expansion under the Patient Protection and Affordable Care Act of 2009 (ACA) on patient outcomes and economic impacts, few studies investigate the fringe effects of this expansion on crime and violence—including the effects on rates of criminal homicide. Using criminal homicide data for the years 2012 to 2016 from the Murder Accountability Project, a non-profit organization that has sued for criminal homicide records from all law enforcement jurisdictions across the US, I estimate the effect of the Medicaid expansion under the ACA on the rate of criminal homicide observed in states that did and did not pursue program expansion. Using a fixed effects model, I find that on average the Medicaid expansion under the ACA led to between a three and four person per million decline in the rate of criminal homicide in states that did expand their Medicaid program as compared to states that did not pursue expansion. This overall reduction is not shared across all races; in fact, black victims saw a relatively minor increase in criminal homicide rates in expansion states. This points to the necessity for innovative policy solutions and program implementation that address the cultural differences in the way in which populations access healthcare to ensure that all populations benefit from health insurance expansion.