Exhibit 4:

Changes in health status among Southern Community Cohort Study participants in Medicaid expansion states from before to after expansion, by type of health

			Difference-in-differences
	Percentage experiencing change with expansion	Counterfactual percentage experiencing change without expansion	Estimate	Percentile rank
Overall health
No change	40.2	38.8	1.4	100.0
Improvement	23.5	23.1	0.45	90.3
Decline	36.3	38.1	−1.8	0.2
Physical health
No change	41.5	39.6	1.9	100.0
Improvement	21.3	21.1	0.17	64.2
Decline	37.2	39.2	−2.0	0.2
Mental health
No change	37.8	36.3	1.5	100.0
Improvement	25.5	24.9	0.62	97.8
Decline	36.8	38.9	−2.1	0.2

SOURCE Authors’ analysis of Southern Community Cohort Study data. NOTES The study states that expanded eligibility for Medicaid and those that did not are listed in the text. The counterfactual expected percentages are based on the observed change over time in the control group (which consisted of participants in nonexpansion states). The difference-in-differences estimates and percentile ranks are explained in the notes to exhibit 3. As noted in the text, mortality was included in the categories of declining health. Separate results for mortality are reported in the appendix (see note 23 in text).