Does Obamacare Care? A Fuzzy Difference-in-Discontinuities Approach

This paper explores the use of fuzzy regression-discontinuity design in the context where multiple treatments are applied at the threshold. The identification result shows that, under a very strong assumption of equality of treatment probability changes at the cutoff point, a difference in fuzzy discontinuity identify a treatment effect of interest. Using the data from the National Health Interview Survey (NHIS), we apply this identification strategy to evaluate the causal effect of the Affordable Care Act (ACA) on health care access and utilization of old Americans. We find results suggesting that the implementation of the Affordable Care Act has led to an increase in the hospitalization rate of elderly American--5% more hospitalization. It has caused a minor increase of cost-related direct barrier to access to care--3.6% increase in the probability of delaying care for cost reasons. The ACA has also exacerbated cost-related barriers to follow-up and continuity care -- 7% more elderly couldn't afford prescriptions, 7% more couldn't see a specialist and, 5.5% more couldn't afford a follow-up visit -- as result of ACA