What effect did the ACA have on out-of-pocket and premium spending?

Bottom Line: The Affordable Care Act (ACA) two years after implementation was associated with reduced out-of-pocket spending overall, particularly among low-income Americans, but spending on premiums also increased.

Why The Research Is Interesting: The ACA expanded health insurance and reduced the number of Americans who couldn't afford medical care mostly by offering free or subsidized insurance coverage to low- and middle-income families. The ACA was implemented in 2014 and data from the first year suggested self-reported household out-of-pocket spending decreased. This study used the most recent available data from 2014 and 2015 to estimate changes in household spending on health care nationwide.

Who and When: 83,341 adults in a nationally representative survey from 2012 through 2015

What: Implementation of the ACA's major insurance programs in 2014 (exposure); average out-of-pocket spending and premium payments and the percentage of individuals facing "high-burden" spending, which was defined as more than 10 percent of a family's income for out-of-pocket expenses, more than 9.5 percent for premium payments and more than 19.5 percent for combined out-of-pocket spending plus premium payments (outcomes)

How (Study Design): Analysis of population-based survey data

Authors: Anna L. Goldman, M.D., M.P.A., of Cambridge Health Alliance, Cambridge, Massachusetts, and coauthors

Results: Average out-of-pocket spending decreased overall, largely because of reductions in spending among people eligible for the Medicaid expansion and cost-sharing and premium subsidies on the insurance exchanges; premium spending went up mostly because of large increases for those with higher incomes; combined out-of-pocket plus premium spending decreased only for those in the lowest-income group.

Study Limitations: Only two years of post-ACA data were available.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamainternmed.2017.8060)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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