The Long Shadow of American Slavery: Its Influence on the Affordable Care Act

Vinish Shrestha ()
Additional contact information
Vinish Shrestha: Department of Economics, Towson University

No 2023-02, Working Papers from Towson University, Department of Economics

Abstract: This study investigates the relationship between slavery and the efficacy of the Affordable Care Act (ACA) in the American South. Using a Causal Forest approach, the results reveal heterogeneous treatment effects of the ACA-Medicaid expansion, with larger reductions in unin- sured rates concentrated in counties with low cotton suitability measures. In Medicaid expansion states, counties more reliant on slavery experienced lower reductions in uninsured rates following the ACA, primarily driven by lower Medicaid coverage among poor Whites. The evidence sug- gests that current political preferences, as explained by determinants of slavery such as cotton suitability and malaria stability indices, serve as a pathway linking the influence of slavery to the health reform. Moreover, the influence of slavery is attenuated in counties that underwent faster mechanization in the mid-1990s. Overall, findings imply that the legacy of slavery has hindered the implementation of the ACA in the South.

Keywords: The Patient Protection and Affordable Care Act (ACA); Slavery; Institution; ACA-related preferences; ACA efficacy; American South; Politics. (search for similar items in EconPapers)
JEL-codes: B15 D02 I14 P00 P43 P46 (search for similar items in EconPapers)
Pages: 63 pages
Date: 2023-04, Revised 2024-07
New Economics Papers: this item is included in nep-hea, nep-his and nep-pke
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

Downloads: (external link)
http://webapps.towson.edu/cbe/economics/workingpapers/2023-02.pdf First version, 2023 (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:tow:wpaper:2023-02

Access Statistics for this paper

More papers in Working Papers from Towson University, Department of Economics Contact information at EDIRC.
Bibliographic data for series maintained by Juergen Jung ().