The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures

Abramowitz, Joelle

doi:10.1177/1077558718768895

Cited by 28 publications

(31 citation statements)

References 32 publications

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“…Our small and insignificant estimates contrast the large, early improvements in these same self-assessed health outcomes seen after the Massachusetts health care reform (Courtemanche and Zapata, 2014;Van der Wees et al, 2013) and randomized Oregon Medicaid experiment (Finkelstein et al, 2012). However, our null results for the Medicaid expansion are consistent with the lack of clear improvements in self-assessed health found by the DD studies in the ACA Medicaid expansion literature (Sommers et al, 2015;Abramowitz, 2016;Simon et al, 2017).…”

Section: Resultssupporting

confidence: 58%

“…7 Using data from the Gallup-Healthways Well-Being Index, Sommers et al (2015) find evidence that the Medicaid expansion improved access along some dimensions but did not significantly affect self-assessed health. Abramowitz (2016) finds that the Medicaid expansion was associated with a reduction in selfreported overall health using data from the Current Population Survey Annual Social and Economic Supplement. Simon et al (2017) use data from the BRFSS and find that the Medicaid expansion increased some aspects of access and preventive care use among low-income childless adults.…”

Section: Effects Of the 2014 Components Of The Acamentioning

confidence: 99%

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Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

et al. 2017

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Any opinions expressed in this paper are those of the author(s) and not those of IZA. Research published in this series may include views on policy, but IZA takes no institutional policy positions. The IZA research network is committed to the IZA Guiding Principles of Research Integrity. The IZA Institute of Labor Economics is an independent economic research institute that conducts research in labor economics and offers evidence-based policy advice on labor market issues. Supported by the Deutsche Post Foundation, IZA runs the world's largest network of economists, whose research aims to provide answers to the global labor market challenges of our time. Our key objective is to build bridges between academic research, policymakers and society. IZA Discussion Papers often represent preliminary work and are circulated to encourage discussion. Citation of such a paper should account for its provisional character. A revised version may be available directly from the author. Terms of use: Documents in James Marton Georgia State University Benjamin Ukert University of Pennsylvania Aaron Yelowitz University of Kentucky Daniela Zapata IMPAQ InternationalAbstrAct mArch 2017 IZA DP No. 10649 Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health * The goal of the Affordable Care Act (ACA) was to achieve nearly universal health insurance coverage through a combination of mandates, subsidies, marketplaces, and Medicaid expansions, most of which took effect in 2014. We use data from the Behavioral Risk Factor Surveillance System to examine the impacts of the ACA on health care access, risky health behaviors, and self-assessed health after two years. We estimate difference-in-differencein-differences models that exploit variation in treatment intensity from state participation in the Medicaid expansion and pre-ACA uninsured rates. Results suggest that the ACA led to sizeable improvements in access to health care in both Medicaid expansion and nonexpansion states, with the gains being larger in expansion states along some dimensions.No statistically significant effects on risky behaviors or self-assessed health emerge for the full sample. However, we find some evidence that the ACA improved self-assessed health among older non-elderly adults, particularly in expansion states. JEL Classification:I12, I13, I18

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Section: Resultssupporting

confidence: 58%

Section: Effects Of the 2014 Components Of The Acamentioning

confidence: 99%

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

et al. 2017

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“…Miller and Wherry analyzed a national survey and found that the Medicaid expansions were associated with a significant decrease in respondents reporting “yes” to questionnaires asking if they were “worried about the ability to pay medical bills in the event of an illness or bad accident and problems paying medical bills.”8 Sommers et al studied the impact of Medicaid expansions using the data from three states (Kentucky, Arkansas, and Texas) and reported that Medicaid expansions were associated with a reduction in annual out-of-pocket spending of $88 11. Other reports include studies recording reduced collection balances in expansion states using credit bureau data,1517 showing a higher likelihood of experiencing zero out-of-pocket spending and zero premium expenditure in expansion states,16 and a study describing changes in out-of-pocket spending using a simple pre-post comparison design without a control 18. While informative, these studies were limited as they were restricted to a small number of states,111213 relied on indirect measures of healthcare spending,8914151617 or did not use a robust study design that evaluated the effect of the Affordable Care Act 18.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence is limited as to whether the Medicaid expansions have improved protection from financial risk. Studies are limited because they used data from a small number of states,111213 relied on indirect measures of financial risk protection (eg, self-report of whether they were worried about the ability to pay medical bills),8914151617 or did not compare states that had expanded Medicaid with those that had not 18. Therefore, whether the Affordable Care Act Medicaid expansions were associated nationally with improved financial risk protection among low income adults remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

Gotanda

Jha

Kominski

et al. 2020

BMJ

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Objective To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). Design Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. Setting United States. Participants A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. Main outcomes and measures Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. Results 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0% (95% confidence interval −38.4% to −15.8%); adjusted absolute change −$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (−29.0% (−40.5% to −15.3%); −$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change −4.7 (−7.9 to −1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. Conclusion Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act’s implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.

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Section: Resultssupporting

confidence: 58%

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

Courtemanche¹,

Marton²,

Ukert³

et al.

Human Rights Documents Online

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and Management Annual Meeting for their valuable comments. Any errors are, of course, our own. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Bureau of Economic Research. NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.

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The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures

Cited by 28 publications

References 32 publications

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

Early Effects of the Affordable Care Act on Health Care Access, Risky Health Behaviors, and Self-Assessed Health

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