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The Institution of American Slavery and the Efficacy of the Affordable Care Act

Vinish Shrestha ()
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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. The results from Causal Forests approach reveal het- erogeneous treatment effects of the ACA-Medicaid expansion, with larger reductions in unin- sured rate concentrated in counties with low cotton suitability measures. In Medicaid-expansion states, counties more reliant on slavery experienced lower reductions in uninsured rate following ACA, primarily driven by lower Medicaid coverage among poor Whites. Conversely, no dis- proportionate reductions in uninsured rates are observed for Black Southerners. The evidence suggests that current political preferences, as explained by determinants of slavery such as cot- ton suitability and malaria stability indices, serve as a pathway linking the influence of slavery to the health reform. Moreover, the impact 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 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: 46 pages
Date: 2023-04, Revised 2024-06
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)

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