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The Impact Of Household Health Insurance Coverage Gains On Children's Achievement In Iowa: Evidence From The ACA - Health Affairs


Low family income is associated with worse child academic achievement. Little is known about how health insurance expansions affect children’s achievement in low-income households. This study examined the effects of the Affordable Care Act’s coverage expansions primarily for Medicaid and Marketplace enrollment, beginning in 2014, on children’s academic achievement in Iowa. The study employed a unique linkage of birth certificates and data on standardized school tests for children in Iowa and took advantage of differences in uninsurance rates across areas in the state before the ACA insurance expansions. There is evidence that the ACA expansions beginning in 2014 were associated with higher reading scores after three years for children born to mothers with a high school education or less. There is no consistent evidence of an effect on math scores. Overall, these findings suggest broad spillover benefits from health insurance expansions to the well-being and development of children in low-income households that should be part of the continuing policy debate surrounding state and national health insurance reforms.