We study the effect of the US Affordable Care Act (ACA) on healthcare borrowing costs. The ACA provides insurance subsidies to low-income enrollees. States could accept funding to expand Medicaid, although many declined, citing the cost burden. The ACA significantly reduced healthcare yields after a favorable 2012 Supreme Court ruling. Furthermore, hospital investment spending increased, and investment-cash flow sensitivities decreased. The yield effect was double in Medicaid expansion states, and insignificant in rural areas of non-expansion states. Our results highlight how the municipal market can be used to evaluate the heterogeneous effects of public policy and guide a targeted policy approach.

我们研究了美国平价医疗法案 (ACA) 对医疗借贷成本的影响。ACA 为低收入参保者提供保险补贴。各州可以接受资金来扩大医疗补助，尽管许多州以成本负担为由拒绝了。在 2012 年最高法院做出有利裁决后，ACA 显着降低了医疗保健收益。此外，医院投资支出增加，投资现金流敏感性下降。医疗补助扩张州的产量效应翻了一番，而在非扩张州的农村地区则微不足道。我们的研究结果强调了如何利用市政市场来评估公共政策的异质性影响并指导有针对性的政策方法。