Work & small business

No significant drop in employment Strong design

In Oregon's randomized lottery, Medicaid had no significant effect on employment or earnings; the results rule out drops larger than 4.4 percentage points.¹ Studies of ACA expansions among childless adults also found no significant employment change.²

Some people do work to keep insurance Strong design

When Tennessee cut public coverage, employment among affected adults rose by about 4.6 percentage points. Some people take or keep jobs mainly for the insurance ("job lock").³

Limits: This finding cuts against expansion: coverage outside work can reduce that pull. It is included because it is real evidence.

Job mobility for single mothers Strong design

Earlier Medicaid expansions for parents reduced job lock for low-income unmarried women but not for men or married women.⁴

Limits: This study looked at pre-ACA parent expansions.

Small-business owners gained coverage Association

Expansion raised insurance coverage among low-income self-employed people, especially the unincorporated self-employed, but did not change how many people became self-employed.⁵

Limits: One conference paper reported more self-employment.⁶ Because the evidence conflicts, this site does not claim that expansion creates entrepreneurs.

Work requirements cut coverage without raising work Strong design

In Arkansas in 2018, coverage among adults ages 30–49 fell by 13.2 percentage points with no significant gain in employment; most people subject to the rule already worked or qualified for an exemption.⁷ Georgia's work-requirement program has enrolled relatively few people, with a large share of its spending on administration.⁸

Limits: Federal law now requires work requirements for expansion adults from January 2027, so they would apply to any Texas expansion.⁹