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Implications of the ACA Medicaid Expansion: A Look at the Data and Evidence

Issue Brief
  1. Frederic Blavin, Michael Karpman, Genevieve Kenney, and Benjamin Sommers, “Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects on Out-Of-Pocket Spending and Coverage,” Health Affairs 37 no. 2 (January 2018): 122-129 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1166

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  2. Kevin Griffith, Leigh Evans, and Jacob Bor, “The Affordable Care Act Reduced Socioeconomic Disparities in Health Care Access,” Health Affairs 36 no. 8 (August 2017), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0083

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  3. For additional study citations supporting this finding, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  4. Aparna Soni, Lindsay Sabik, Kosali Simon, and Benjamin Sommers, “Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act,” Journal of the American Medical Association 4, no. 1 (January 2018): 122-124, https://jamanetwork.com/journals/jamaoncology/article-abstract/2657670?redirect=true&redirect=true

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  5. Julie Hudson and Asako Moriya, “Medicaid Expansion for Adults Had Measureable ‘Welcome Mat’ Effects on Their Children,” Health Affairs, 36 no. 9 (September 2017), https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0347

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  6. Michael Dworsky, Carrie Farmer, and Mimi Shen, Veterans’ Health Insurance Coverage Under the Affordable Care Act and Implications of Repeal for the Department of Veterans Affairs, (RAND Corporation, 2017), https://www.rand.org/pubs/research_reports/RR1955.html

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  7. Jack Hoadley, Karina Wagnerman, Joan Alker, and Mark Holmes, Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities (Washington, DC: Georgetown Center for Children and Families, June 2017), https://ccf.georgetown.edu/wp-content/uploads/2017/06/Rural-health-final.pdf

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  8. For additional study citations supporting this finding, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  9. Thomas Buchmueller, Zachary Levinson, Helen Levy, and Barbara Wolfe, “Effect of the Affordable Care Act on Racial and Ethnic Disparities in Health Insurance Coverage,” American Journal of Public Health (May 2016), http://www.ncbi.nlm.nih.gov/pubmed/27196653

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  10. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  11. MaryBeth Musumeci, Data Note: Data Do Not Support Relationship Between States’ Medicaid Expansion Status and Community-Based Services Waiver Waiting Lists (Washington, DC: Kaiser Family Foundation, February 2017), https://www.kff.org/medicaid/issue-brief/data-note-data-do-not-support-relationship-medicaid-expansion-hcbs-waiver-waiting-lists/

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  12. Aparna Soni, Kosali Simon, John Cawley, and Lindsay Sabik, “Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses,” American Journal of Public Health epub ahead of print (December 2017), http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2017.304166

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  13. United States Government Accountability Office (GAO), Medicaid Expansion: Behavioral Health Treatment Use in Selected States in 2014 (Washington, DC: GAO Report to Congressional Requesters, June 2017), https://www.gao.gov/assets/690/685415.pdf

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  14. Benjamin Sommers, Robert Blendon, E. John Orav, Arnold Epstein, “Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance,” The Journal of the American Medical Association 176 no. 10 (October 2016): 1501-1509, http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2542420

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  15. Andrew Loehrer et al., “Association of the Affordable Care Act Medicaid Expansion with Access to and Quality of Care for Surgical Conditions,” Journal of the American Medical Association Surgery, epub ahead of print (January 2018), https://jamanetwork.com/journals/jamasurgery/article-abstract/2670459?redirect=true

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  16. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  17. Sarah Miller and Laura Wherry, “Health and Access to Care During the First 2 Years of the ACA Medicaid Expansions,” The New England Journal of Medicine 376 no. 10 (March 2017), http://www.nejm.org/doi/full/10.1056/NEJMsa1612890

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  18. Molly Candon et al., Primary Care Appointment Availability and the ACA Insurance Expansions (Philadelphia, PA: University of Pennsylvania Leonard Davis Institute of Health Economics, March 2017), https://ldi.upenn.edu/brief/primary-care-appointment-availability-and-aca-insurance-expansions

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  19. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  20. Frederic Blavin, Michael Karpman, Genevieve Kenney, and Benjamin Sommers, “Medicaid Versus Marketplace Coverage for Near-Poor Adults: Effects on Out-Of-Pocket Spending and Coverage,” Health Affairs 37 no. 2 (January 2018): 122-129 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.1166

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  21. Kenneth Brevoort, Daniel Grodzicki, and Martin Hackmann, Medicaid and Financial Health (National Bureau of Economic Research, Working Paper No. 24002, November 2017), http://www.nber.org/papers/w24002

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  22. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  23. Kyle Caswell and Timothy Waidmann, The Affordable Care Act Medicaid Expansions and Personal Finance (Washington, DC: The Urban Institute, September 2017), https://www.urban.org/research/publication/affordable-care-act-medicaid-expansions-and-personal-finance

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  24. Luojia Hu, Robert Kaestner, Bhashkar Mazumder, Sarah Miller, and Ashley Wong, The Effect of the Patient Protection and Affordable Care Act Medicaid Expansions on Financial Well-Being (Working Paper No. 22170, National Bureau of Economic Research, April 2016), http://www.nber.org/papers/w22170?utm_campaign=ntw&utm_medium=email&utm_source=ntw

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  25. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  26. The Ohio Department of Medicaid, Ohio Medicaid Group VIII Assessment: A Report to the Ohio General Assembly (The Ohio Department of Medicaid, January 2017), http://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Assessment.pdf

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  27. Julia Paradise, Data Note: Three Findings about Access to Care and Health Outcomes in Medicaid (Washington, DC: Kaiser Family Foundation, March 2017), https://www.kff.org/medicaid/issue-brief/data-note-three-findings-about-access-to-care-and-health-outcomes-in-medicaid/

     

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  28. Julia Paradise, Data Note: Three Findings about Access to Care and Health Outcomes in Medicaid (Washington, DC: Kaiser Family Foundation, March 2017), https://www.kff.org/medicaid/issue-brief/data-note-three-findings-about-access-to-care-and-health-outcomes-in-medicaid/

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  29. Julia Paradise, Data Note: Three Findings about Access to Care and Health Outcomes in Medicaid (Washington, DC: Kaiser Family Foundation, March 2017), https://www.kff.org/medicaid/issue-brief/data-note-three-findings-about-access-to-care-and-health-outcomes-in-medicaid/

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  30. Benjamin Sommers, Bethany Maylone, Robert Blendon, E. John Orav, and Arnold Epstein, “Three-Year Impacts of the Affordable Care Act: Improved Medical Care and Health Among Low-Income Adults,” Health Affairs epub ahead of print (May 2017), http://content.healthaffairs.org/content/early/2017/05/15/hlthaff.2017.0293

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  31. Eric Charles et al., “Impact of Medicaid Expansion on Cardiac Surgery Volume and Outcomes,” The Annals of Thoracic Surgery (June 2017), http://www.annalsthoracicsurgery.org/article/S0003-4975(17)30552-0/pdf

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  32. Chintan Bhatt and Consuelo Beck-Sague, “Medicaid Expansion and Infant Mortality in the United States,” American Journal of Public Health (January 2018) e1-e3, http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2017.304218

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  33. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  34. Benjamin Sommers and Jonathan Gruber, “Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion,” Health Affairs epub ahead of print (April 2017), http://content.healthaffairs.org/content/early/2017/04/10/hlthaff.2016.1666.full

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  35. April Grady, Deborah Bachrach, and Patti Boozang, Medicaid’s Role in the Delivery and Payment of Substance Use Disorder Services in Montana, (Manatt Health, March 2017), http://mthcf.org/wp-content/uploads/2017/03/Medicaid-Role-in-Substance-Use-Disorder-Services-in-Montana_Final.pdf

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  36. Aparna Soni, Marguerite Burns, Laura Dague, and Kosali Simon, “Medicaid Expansion and State Trends in Supplemental Security Income Program Participation,” Health Affairs 36 no. 8, (August 2017): 1485-1488, http://content.healthaffairs.org/content/36/8/1485.full?sid=982b20c0-0a17-4dc4-a35a-b0302d4ec289

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  37. Jacob Vogler, Access to Health Care and Criminal Behavior: Short-Run Evidence from the ACA Medicaid Expansions (University of Illinois at Urbana-Champaign, November 2017), https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3042267

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  38. Deborah Bachrach, Patricia Boozang, Avi Herring, and Dori Glanz Reyneri, States Expanding Medicaid See Significant Budget Savings and Revenue Gains, (Manatt Health Solutions, prepared by the Robert Wood Johnson Foundation’s State Health Reform Assistance Network, March 2016), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2016/rwjf419097

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  39. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  40. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana (Missoula, MT: University of Montana Bureau of Business and Economic Research, April 2018), https://mthcf.org/wp-content/uploads/2018/04/BBER-MT-Medicaid-Expansion-Report_4.11.18.pdf

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  41. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Public Administration Institute at Louisiana State University, prepared for the Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf

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  42. Kaiser Family Foundation analysis of Medicaid spending and enrollment data collected from the Medicaid Budget and Expenditure System (MBES), Centers for Medicare and Medicaid Services, accessed October 2017.

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  43. Ibid.

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  44. Robin Rudowitz and Allison Valentine, Medicaid Enrollment & Spending Growth: FY 2017 and 2018, (Washington, DC: Kaiser Family Foundation, October 2017), https://www.kff.org/medicaid/issue-brief/medicaid-enrollment-spending-growth-fy-2017-2018/

    At least six states (including AR, AZ, CO, IN, LA, NH) reported funding all or part of the state share of Medicaid expansion costs with provider taxes as of Summer 2017. Data on financing of the state share of expansion costs were collected as part of the FY 2017 and 2018 budget survey of Medicaid officials conducted by KFF and HMA but were not published in the associated spending and enrollment growth report.

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  45. Ballotpedia, “Oregon Measure 101, Healthcare Insurance Premiums Tax for Medicaid Referendum,” (January 2018),  https://ballotpedia.org/Oregon_Measure_101,_Healthcare_Insurance_Premiums_Tax_for_Medicaid_Referendum_(January_2018)

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  46. Kaiser Family Foundation analysis of Medicaid spending and enrollment data collected from the Medicaid Budget and Expenditure System (MBES), Centers for Medicare and Medicaid Services, accessed October 2017.

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  47. Fredric Blavin, How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data (The Urban Institute, April 2017), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2017/rwjf436310

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  48. Kurt Gillis, Physicians’ Patient Mix – A Snapshot from the 2016 Benchmark Survey and Changes Associated with the ACA (American Medical Association, October 2017), https://www.ama-assn.org/sites/default/files/media-browser/public/health-policy/PRP-2017-physician-benchmark-survey-patient-mix.pdf

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  49. For additional study citations supporting these findings, see:

    Larisa Antonisse, Rachel Garfield, Robin Rudowitz, and Samantha Artiga, The Effects of Medicaid Expansion under the ACA: Updated Findings from a Literature Review (Washington, DC: Kaiser Family Foundation, March 2018), https://www.kff.org/medicaid/issue-brief/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-march-2018/

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  50. Richard Lindrooth, Marcelo Perraillon, Rose Hardy, and Gregory Tung, “Understanding the Relationship Between Medicaid Expansions and Hospital Closures,” Health Affairs epub ahead of print (January 2018), https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0976

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  51. The Colorado Health Foundation, Assessing the Economic and Budgetary Impact of Medicaid Expansion in Colorado, (The Colorado Health Foundation, March 2016).

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  52. Deloitte Development LLC, Commonwealth of Kentucky Medicaid Expansion Report (February 2015).

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  53. John Ayanian, Gabriel Ehrlich, Donald Grimes, and Helen Levy, “Economic Effects of Medicaid Expansion in Michigan,” The New England Journal of Medicine epub ahead of print (January 2017), http://www.nejm.org/doi/full/10.1056/NEJMp1613981

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  54. Pennsylvania Department of Human Services, Medicaid Expansion Report (Pennsylvania Department of Human Services, January 2017),  http://www.dhs.pa.gov/cs/groups/webcontent/documents/document/c_257436.pdf

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  55. Bryce Ward and Brandon Bridge, The Economic Impact of Medicaid Expansion in Montana (Missoula, MT: University of Montana Bureau of Business and Economic Research, April 2018), https://mthcf.org/wp-content/uploads/2018/04/BBER-MT-Medicaid-Expansion-Report_4.11.18.pdf

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  56. James Richardson, Jared Llorens, and Roy Heidelberg, Medicaid Expansion and the Louisiana Economy (Public Administration Institute at Louisiana State University, prepared for the Louisiana Department of Health, March 2018), http://gov.louisiana.gov/assets/MedicaidExpansion/MedicaidExpansionStudy.pdf

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  57. The Ohio Department of Medicaid, Ohio Medicaid Group VIII Assessment: A Report to the Ohio General Assembly (The Ohio Department of Medicaid, January 2017), http://medicaid.ohio.gov/Portals/0/Resources/Reports/Annual/Group-VIII-Assessment.pdf

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  58. Heeju Sohn and Stefan Timmermans, “Social Effects of Health Care Reform: Medicaid Expansion under the Affordable Care Act and Changes in Volunteering,” Socius: Socialogical Research for a Dynamic World 3 (March 2017): 1-12, http://journals.sagepub.com/doi/full/10.1177/2378023117700903

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  59. Rachel Garfield, Robin Rudowitz, and Anthony Damico, Understanding the Intersection of Medicaid and Work (Washington, DC: Kaiser Family Foundation, January 2018), https://www.kff.org/medicaid/issue-brief/understanding-the-intersection-of-medicaid-and-work/

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  60. Steve Crabtree, “In U.S., Depression Rates Higher for Long-Term Unemployed,” Gallup (June 2014), http://news.gallup.com/poll/171044/depression-rates-higher-among-long-term-unemployed.aspx

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  61. Gordon Waddell and A. Kim Burton, Is Work Good for your Health and Well-Being?, (2006).

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  62. Pekka Virtanen et al., “Temporary Employment and Health: A Review,” International Journal of Epidemiology 34 (2005): 610-622.

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  63. Pekka Virtanen, Urban Janlert, and Anne Hammarstrom, “Exposure to temporary employment and job insecurity: A Longitudinal Study of the Health Effects,” Occupational and Environmental Medicine, 68, no. 8 (August 2011): 570-574.

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  64. Gordon Waddell and A. Kim Burton, Is Work Good for your Health and Well-Being?, (2006).

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  65. Gordon Waddell and A. Kim Burton, Is Work Good for your Health and Well-Being?, (2006).

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  66. MaryBeth Musumeci and Julia Zur, Medicaid Enrollees and Work Requirements: Lessons from the TANF Experience (Washington, DC: Kaiser Family Foundation, August 2017), https://www.kff.org/medicaid/issue-brief/medicaid-enrollees-and-work-requirements-lessons-from-the-tanf-experience/

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  67. Heather Hahn et al., Work Requirements in Social Safety Net Programs (Washington, DC: The Urban Institute, December 2017), https://www.urban.org/sites/default/files/publication/95566/work-requirements-in-social-safety-net-programs.pdf

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  68. LaDonna Pavetti, Work Requirements Don’t Cut Poverty, Evidence Shows (Center on Budget and Policy Priorities, June 2016), https://www.cbpp.org/research/poverty-and-inequality/work-requirements-dont-cut-poverty-evidence-shows

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