Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act

Goldman, Anna L.; Woolhandler, Steffie; Himmelstein, David U.; Bor, David H.; McCormick, Danny

doi:10.1001/jamainternmed.2017.8060

Cited by 78 publications

(125 citation statements)

References 26 publications

Supporting

Mentioning

121

Contrasting

Order By: Relevance

“…In the pre-ACA period, 29% of lowest-income patients experienced CHE each year compared with 16% of all nonelderly US adults with the same income. 17 Among lowest-income patients who were admitted to the hospital with trauma, the likelihood of CHE before implementation of the ACA was higher still, at 37%. Lowest-income patients also experienced larger gains in financial protection than all nonelderly US adults with the same income, seeing a 39% decrease in odds of CHE vs a 16% decrease in all adults.…”

Section: Discussionmentioning

confidence: 99%

“…Lowest-income patients also experienced larger gains in financial protection than all nonelderly US adults with the same income, seeing a 39% decrease in odds of CHE vs a 16% decrease in all adults. 17 To our knowledge, our study is the first to examine catastrophic expenditures among US patients with traumatic injury using out-of-pocket spending reported directly by households.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of the US Affordable Care Act With Out-of-Pocket Spending and Catastrophic Health Expenditures Among Adult Patients With Traumatic Injury

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Trauma is an expensive and unpredictable source of out-of-pocket spending for American families. The Patient Protection and Affordable Care Act (ACA) sought to improve financial protection by expanding health insurance coverage, but its association with health care spending for patients with traumatic injury remains largely unknown.OBJECTIVE To evaluate the association of ACA implementation with out-of-pocket spending, premiums, and catastrophic health expenditures (CHE) among adult patients with traumatic injury. DESIGN, SETTING, AND PARTICIPANTSData from a nationally representative sample of US adults aged 19 to 64 years who had a hospital stay or emergency department visit for a traumatic injury from January 2010 to December 2017 were analyzed using the Medical Expenditure Panel Survey.Multivariable generalized linear models were used to evaluate changes in spending after ACA implementation. Additionally, 4 income subgroups were evaluated based on ACA thresholds for program eligibility: lowest-income patients (earning 138% or less of the federal poverty level [FPL]), low-income patients (earning 139% to 250% of the FPL), middle-income patients (earning 251% to 400% of the FPL), and high-income patients (earning more than 400% of the FPL). Data were MAIN OUTCOMES AND MEASURES Out-of-pocket spending, premium spending, out-of-pocket plus premium spending, and likelihood of experiencing CHE, defined as out-of-pocket plus premium spending exceeding 19.5% of family income. RESULTSOf the 6288 included patients, 2995 (weighted percentage, 51.3%) were male, and the mean (SD) age was 41.4 (12.8) years. Implementation of the ACA was associated with 31% lower odds of CHE (adjusted odds ratio, 0.69; 95% CI, 0.54 to 0.87; P = .002). Changes were greatest in lowest-income patients, who experienced 30% lower out-of-pocket spending (adjusted percentage change, −30.4%; 95% CI, −46.6% to −9.4%; P = .01), 26% lower out-of-pocket plus premium spending (adjusted percentage change, −26.3%; 95% CI, −41.0% to −8.1%; P = .01), and 39% lower odds of CHE (adjusted odds ratio, 0.61; 95% CI, 0.44 to 0.84; P = .002). Low-income patients experienced decreased out-of-pocket spending and out-of-pocket plus premium spending but no changes in CHE, while middle-income and high-income patients experienced no significant changes in any spending outcome. In the post-ACA period, 1 in 11 of all patients with traumatic injury and 1 in 5 with the lowest incomes continued to experience CHE each year.CONCLUSIONS AND RELEVANCE Implementation of the ACA was associated with improved financial protection for US adults with traumatic injury, especially lowest-income individuals targeted (continued) Key Points Question Was the implementation of the Patient Protection and Affordable Care Act (ACA) associated with improved financial protection for US adults receiving care for traumatic injuries? Findings In this cross-sectional study of 6288 adult patients with traumatic injury, implementation of the ACA was associated with 31% lower odds of catastroph...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association of the US Affordable Care Act With Out-of-Pocket Spending and Catastrophic Health Expenditures Among Adult Patients With Traumatic Injury

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The 2 largest categories of spending are insurance premiums and medications, consistent with studies for other conditions. 6,19,22 These expenses are particularly high among those covered with self-purchased private insurance. Under these insurance programs, patients are more likely to bear out-of-pocket costs for services that are usually subsidized by employers and manifest as high insurance premiums, as well as high deductible expenses and coinsurance payments for most health care services.…”

Section: Discussionmentioning

confidence: 99%

“…Further, annual outof-pocket expenses on insurance premiums were obtained on a family level, as recommended by the Agency of Healthcare Research and Quality. 6,19 The total out-of-pocket health expenses represent the sum of insurance premiums and costs of all health care services.…”

Section: Study Outcomesmentioning

confidence: 99%

“…4 However, there have been concerns that the expanded coverage may not adequately protect individuals from financial adversity, especially due to high health insurance premiums and out-of-pocket expenses. [5][6][7][8] Moreover, while contemporary insurance reforms introduced upper limits on out-of-pocket health care expenses, 9 these limits have not been scaled to income. 9 In addition, upcoming insurance policy changes may further limit the coverage of important services by insurance programs.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States

et al. 2018

View full text Add to dashboard Cite

One in 4 low-income families with a member with ASCVD, including those with insurance coverage, experience a high financial burden, and 1 in 10 experience a catastrophic financial burden due to cumulative out-of-pocket health care expenses. To alleviate economic disparities, policy interventions must extend focus to improving not only access, but also quality of coverage, particularly for low-income families.

show abstract

Medicaid Expansion Gains Momentum

Goldman

Sommers

2019

JAMA

Self Cite

View full text Add to dashboard Cite

Health care was rated one of the key issues for voters in the 2018 midterm elections, according to exit polls. The election results set the stage for as many as 500 000 low-income individuals in the United States to gain coverage through new state Medicaid expansions under the Affordable Care Act (ACA). Expansion could occur in 5 additional states: 3 through ballot measures (Idaho, Nebraska, and Utah) and 2 through the election of new governors supportive of expansion (Kansas and Maine). If all 5 states expand Medicaid, this will bring the number of expansion states to 37 (plus Washington, DC), with a potential increase in Medicaid enrollees from approximately 50 million in 2010 prior to enactment of the ACA to a projected 76 million by 2020 (Figure and eFigure in the Supplement). The election also brings some short-term legislative certainty for the ACA, as the new Democratic majority in the House of Representatives will forestall further attempts to repeal the law for at least 2 years. In this Viewpoint, we provide a postelection update on the status of the Medicaid expansion and recent research on the ongoing effects of the law.Two gubernatorial elections will likely result in new state Medicaid expansions. Maine became the first state to expand Medicaid through a ballot initiative in Decem-ber2017,butRepublicanGovPaulLePagerefusedtoimplement the program, despite court orders to do so. Democrat Janet Mills campaigned on expanding Medicaid, and her election creates a clear path forward for the expansion. Although such projections are inherently imprecise, policy analysts estimate that Medicaid expansion in Maine could cover an additional 56 000-72 000 individuals (eTable in the Supplement). Medicaid expansion is also a strong possibility in Kansas, where newly elected Democrat Laura Kelly is committed to expansion. She will have the likely support of the Republican-controlled legislature, which passed a Medicaid expansion bill in 2017 that was vetoed by then Gov Sam Brownback. Medicaid expansion in Kansas could provide coverage to an additional estimated 129 000-152 000 Kansans. Wisconsin also elected a new governor, Democrat Tony Evers, who has indicated support for expanding Medicaid, although the state's legislature remains opposed, making an imminent expansion in Wisconsin unlikely.Ballot initiatives supporting Medicaid expansion were successful in 3 states, although as in Maine, expansions in thesestatescouldbeblockedbystateofficialswhooppose the change. However, if the initiatives are implemented, Utah is expected to experience the largest Medicaid coverage expansion, with an estimated 100 000-158 000 new beneficiaries. The Utah ballot measure finances the program through an increase in the state sales tax, which is expected to cover the full $77 million projected annual cost to the state of expansion. In Idaho, an estimated 51 000-119 000 individuals are expected to enroll in Medicaid, at a projected annual cost to the state of $39 million to $42 million. In Nebraska, an estimated 68 000-93 000 individua...

show abstract

Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act

Abstract: Act (ACA) was associated with a reduced number of Americans who reported being unable to afford medical care, but changes in actual health spending by households are not known. OBJECTIVES To estimate changes in household spending on health care nationwide after implementation of the ACA.

Cited by 78 publications

References 26 publications

Association of the US Affordable Care Act With Out-of-Pocket Spending and Catastrophic Health Expenditures Among Adult Patients With Traumatic Injury

Association of the US Affordable Care Act With Out-of-Pocket Spending and Catastrophic Health Expenditures Among Adult Patients With Traumatic Injury

Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States

Medicaid Expansion Gains Momentum

Contact Info

Product

Resources

About