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ACA reduces out-of-pocket medical expenses

The implementation of the ACA reduced out-of-pocket spending for medical care, especially for low-income individuals; however, premium spending remained high for these individuals, according to findings published in JAMA Internal Medicine.

“The Affordable Care 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,” Anna L. Goldman, MD, MPA, from the Cambridge Health Alliance, and colleagues wrote.

Goldman and colleagues studied population-based data from the 2012 to 2015 Medical Expenditure Panel Survey to determine if the implementation of the ACA reduced out-of-pocket medical expenses, household premium contributions and total health spending (out-of-pocket plus premiums). A total of 83,431 adults aged between 18 and 64 years completed the survey (49.1% men; mean age, 40.3 years).

Participants were categorized into one of four income groups: lowest income (family incomes of 138% or less of the federal poverty level [FPL]), low income (family incomes of 139% to 250% of the FPL), middle income (family incomes of 251% to 400% of the FPL) and higher income (family incomes above 400% of FPL).

Results showed that ACA implementation reduced mean out-of-pocket spending by 11.9% (95% CI, 17.1 to 6.4) among all participants, 21.4% (95% CI, 30.1 to 11.5) in the lowest-income group, 18.5% (95% CI, 27 to 9) in the low-income group and 12.8% (95% CI, 22.1 to 2.4) in the middle-income group.

There was an increase in mean premium spending of 12.1% (95% CI, 1.9-23.3) in the full sample and 22.9% (95% CI, 5.5-43.1) in the higher-income group. Only the lowest-income group demonstrated a reduction in combined out-of-pocket plus premium spending (16%; 95% CI, 27.6 to 2.6).

There was a decline in the probability of household out-of-pocket spending exceeding 10% of family income among the full sample (OR = 0.8; 95% CI, 0.7-0.9) and lowest-income group (OR = 0.8; 95% CI, 0.67-0.97). The middle-income group showed an increase in the odds of high-burden premium spending (OR = 1.28; 95% CI, 1.03-1.59).

“Our findings carry several implications for the health reform debate. First, the ACA was associated with moderate reductions in the cost burden for lowest-, low-, and middle-income households, which represents incremental but important progress,” Goldman and colleagues concluded. “Repealing or otherwise dismantling the legislation without a suitable replacement could cause financial harm to many lower income families.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.