The Long-Run Effects of the Affordable Care Act: Evidence from a Partially Pre-Committed Research Design Over the COVID-19 Recession and Recovery

Jeffrey Clemens, Anwita Mahajan and Joseph J. Sabia

No 35190, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: Adjustment frictions can cause the long-run effects of social insurance reforms to differ from their short-run effects. Using pre-committed extensions of event study specifications applied previously for short-run analyses, we test the hypothesis that the Affordable Care Act’s (ACA) impacts on insurance coverage and employment would increase following the substantial churn generated by the COVID-19 pandemic. Contrary to the hypothesis, the ACA’s impacts remained stable through the pandemic. Long-run effects on employment and employer coverage were modest and much smaller than initially projected. Our study illustrates how partially pre-committed designs can yield informative long-run estimates while limiting specification search.

JEL-codes: H51 H75 I13 (search for similar items in EconPapers)
Date: 2026-05
Note: AG EH LS PE
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