Medicaid expansion and non-alcoholic beverage choices by low-income households

Abstract

This article investigates the impact of the 2010 Patient Protection and Affordable Care Act (ACA) on the healthfulness of non-alcoholic beverage (NAB) choices of low-income households. A theoretical analysis proposes an income effect that increases unhealthy beverage purchases after Medicaid expansion and a nutrition education effect that decreases them. To empirically test these effects, we utilize household-level data for NAB purchases in 52 U.S. metropolitan areas. Our identification strategy is based on eligible households following the 2012 Supreme Court ruling that allowed states to opt out of Medicaid expansion. We examine changes in purchases across NAB categories and in purchases at the product-brand level. Empirical results indicate that Medicaid expansion resulted in eligible households buying more diet carbonated soft drinks (CSDs) and bottled water, with no effect on regular CSDs, fruit juice, fruit drinks, milk, or tea. Moreover, the expansion led to decreases in sugar purchases and increases in purchases of NAB products with lower sugar content, highlighting the benefits of supplementing the medical benefits of Medicaid with diet quality programs, such as nutrition education.

Keywords: Medicaid expansion; bottled water; carbonated soft drinks; low-income households.