Catastrophic Health Expenditures Across Insurance Types and Incomes Before and After the Patient Protection and Affordable Care Act

Liu, Charles; Chhabra, Karan R.; Scott, John W.

doi:10.1001/jamanetworkopen.2020.17696

Cited by 28 publications

(41 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that becoming eligible for Medicare at age 65 years was associated with a 27% reduction in OOP spending and a 35% reduction in the risk of catastrophic health care expenditures for older adults from 2014 through 2018. These findings extend those of previous work 4 , 5 , 6 by quantifying the type of spending changes and magnitude of financial risk protection currently associated with Medicare. Despite the substantial health insurance coverage gains attributable to the Affordable Care Act, nearly 9% of adults aged 64 years still experienced CHE from 2014 through 2018.…”

Section: Discussionsupporting

confidence: 83%

“…Following previous work, 1 , 2 we used a second-order local polynomial regression discontinuity design to evaluate changes associated with Medicare eligibility at age 65 years. Outcomes included insurance coverage (any Medicaid, Medicare, any private or uninsured), mean annual income, mean annual medical charges, mean annual OOP health care spending (exclusive of premiums), CHE (defined as OOP spending ≥40% of annual income minus spending on food and housing), 3 , 4 and delaying care because of affordability.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility

et al. 2021

Self Cite

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 83%

Section: Methodsmentioning

confidence: 99%

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility

et al. 2021

Self Cite

View full text Add to dashboard Cite

“…This occurred in the policy context of coverage expansions under the Affordable Care Act (ACA), which reduced the number of uninsured among non-elderly adult Americans by 41% between 2010 and 2016, 38 and has been associated with a reduction in 2 million US adults facing CHE. 39 However, the present study suggests that this stagnation in CHE risk among treat-and-release ED visits was temporary and has risen since 2016.…”

Section: Discussionmentioning

confidence: 58%

“…An analysis of national trends in CHE (using a data set that includes actual out-of-pocket payments) suggested that the majority of individuals in the US who experience CHE every year have private health insurance. 39 This suggests that additional strategies are needed to mitigate CHE risk for acute, unscheduled care. Such strategies may include expanding meaningful insurance coverage for when unexpected health problems arise, bolstering state or federal incentives to curb excessive charges, 43 mitigating aggressive financial collection practices, 44 and further assessing payment structures for ED care to ensure that the ED is adequately compensated for its mission and service to the community while not becoming a place to which people hesitate turning to owing to costs alone.…”

Section: Discussionmentioning

confidence: 99%

Assessing Catastrophic Health Expenditures Among Uninsured People Who Seek Care in US Hospital-Based Emergency Departments

Scott

Sabbatini

et al. 2021

JAMA Health Forum

Self Cite

View full text Add to dashboard Cite

IMPORTANCEUninsured people uniquely rely on the emergency department (ED) for care as they are less likely to have access to lower-cost alternatives. Prior work has demonstrated that most uninsured patients are at risk of catastrophic health expenditure (CHE) after being hospitalized for life-saving care. The risk of CHE for a single treat-and-release ED visit that does not result in a hospitalization among uninsured patient encounters is currently unknown. OBJECTIVE To estimate the overall national risk of CHE among uninsured patients after a single treat-and-release ED visit from 2006 through 2017, and to characterize this risk across key traits. DESIGN, SETTING, AND POPULATION This cross-sectional study is based on a nationally representative sample of hospital-based ED visits between 2006 and 2017 in the United States (US) from the Nationwide Emergency Department Sample (NEDS). It examined outpatient ED visits among uninsured patients. MAIN OUTCOMES AND MEASURESRisk of CHE for ED care defined as an ED charge that exceeds 40% of one's estimated annual post-subsistence income. RESULTSFrom 2006 to 2017, there were 41.7 million NEDS encounters that met inclusion criteria for this analysis, equating to a nationally weighted estimate of 184.6 million uninsured treat-andrelease ED encounters over this period. The median ED charge for a single treat-and-release

show abstract

“…Furthermore, patients from low-income families were at higher risk of CHE with private insurance coverage vs Medicaid, in agreement with a recent study of a noncancer population. 31 Underinsurance owing to high premiums likely counterbalanced cost savings from gaining private insurance coverage. It seems that low-income patients with cancer are better protected from CHE by Medicaid coverage than by private insurance coverage.…”

Section: Discussionmentioning

confidence: 99%

Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States

Albright

Chino

et al. 2021

JAMA Netw Open

View full text Add to dashboard Cite

IMPORTANCE Health insurance coverage is dynamic in the United States, potentially changing from month to month. The Patient Protection and Affordable Care Act (ACA) aimed to stabilize markets and reduce financial burden, particularly among those with preexisting conditions. OBJECTIVE To describe the risks of insurance churn (ie, gain, loss, or change in coverage) and catastrophic health expenditures among nonelderly patients with cancer in the United States, assessing for changes associated with ACA implementation. DESIGN, SETTING, AND PARTICIPANTS This retrospective, cross-sectional study uses data from the Medical Expenditure Panel Survey, a representative sample of the US population from 2005 to 2018. Respondents included were younger than 65 years, identified by health care use associated with a cancer diagnosis code in the given year. Statistical analysis was conducted from July 30, 2020, to January 5, 2021. EXPOSURES The Patient Protection and Affordable Care Act. MAIN OUTCOMES AND MEASURES Survey weights were applied to generate estimates for the US population. Annual risks of insurance churn (ie, any uninsurance or insurance change or loss) and catastrophic health expenditures (spending >10% income) were calculated, comparing subgroups with the adjusted Wald test. Weighted multivariable linear regression was used to assess for changes associated with ACA implementation. RESULTS From 6069 respondents, we estimated a weighted mean of 4.78 million nonelderly patients (95% CI, 4.55-5.01 million; female patients: weighted mean, 63.9% [95% CI, 62.2%-65.7%]; mean age, 50.3 years [95% CI, 49.7-50.8 years]) with cancer annually in the United States. Patients with cancer experienced lower annual risks of insurance loss (5.3% [95% CI, 4.5%-6.1%] vs 7.6%[95% CI, 7.4%-7.8%]) and any uninsurance (14.6% [95% CI, 13.3%-16.0%] vs 24.1% [95% CI, 23.5%-24.7%]) but increased risk of catastrophic health expenditures (expenses alone: 12.4% [95% CI, 11.2%-13.6%] vs 6.3% [95% CI, 6.2%-6.5%]; including premiums: 26.6% [95% CI, 25.0%-28.1%] vs 16.5% [95% CI, 16.1%-16.8%]; P < .001) relative to the population without cancer. Patients with cancer from low-income families and with full-year private coverage were at particularly high risk of catastrophic health expenditures (including premiums: 81.7% [95% CI, 74.6%-88.9%]). After adjustment, low income was the factor most strongly associated with both insurance churn and catastrophic spending, associated with annual risk increases of 6.5% (95% CI, 4.2%-8.8%) for insurance loss, 17.3% (95% CI, 13.4%-21.2%) for any uninsurance, and 37.4% (95% CI, 33.3%-41.6%) for catastrophic expenditures excluding premiums (P < .001). In adjusted models relative to 2005-2009, full ACA implementation (2014)(2015)(2016)(2017)(2018) was associated with a decreased annual risk of any (continued) Key Points Question Was the Patient Protection and Affordable Care Act (ACA) associated with reductions in risks of insurance churn (ie, gain, loss, or change in coverage) and catastrophic health expenditures for n...

show abstract

Catastrophic Health Expenditures Across Insurance Types and Incomes Before and After the Patient Protection and Affordable Care Act

Cited by 28 publications

References 5 publications

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility

Assessing Catastrophic Health Expenditures Among Uninsured People Who Seek Care in US Hospital-Based Emergency Departments

Associations of Insurance Churn and Catastrophic Health Expenditures With Implementation of the Affordable Care Act Among Nonelderly Patients With Cancer in the United States

Contact Info

Product

Resources

About