Affordable Care Act linked to decreased out-of-pocket spending for healthcare

1. In this analysis of healthcare spending survey data from a nationally represented sample, the implementation of the Affordable Care Act (ACA) was associated with a decrease in mean out-of-pocket spending for healthcare. Mean premium spending increased during this same time period.

2. Participants in the low-income groups were more likely to have a reduction in out-of-pocket spending, while those in the high-income group had the highest premium increase.

Evidence Rating Level: 3 (Average)      

Study Rundown: The ACA was implemented in 2014 with the aim of expanding medical coverage, in part by expanding subsidized coverage to those from low- and middle-income families. Careful study of how these policies affect real-world spending practices are important to inform further legislation. The current study used nationally representative survey data on household income and healthcare spending practices to evaluate the effects of ACA implementation. The study found that overall, mean out-of-pocket spending decreased while mean premium spending increased since the implementation of ACA. The low-income groups had greater decrease in out-of-pocket spending while the higher income group had the greater increase in premium spending.

The strengths of the study included its nationally representative sample and stratification by income group allowing for unique insight into policy ramifications. The main limitations of the study included the short time period between ACA implementation and the survey data, as well as the lack of data on Medicare part B premiums affecting elderly patients.

Click to read the study, published in JAMA Internal Medicine

Relevant Reading: Reducing Young Adults’ Health Care Spending through the ACA Expansion of Dependent Coverage

In-Depth [survey]: This study used data from the Medical Expenditure Panel Survey (MEPS) from January 1, 2012 to December 31, 2015, which is a nationwide survey of US noninstitutionalized civilians. The study included data on adults aged 18-64 years. Income groups included lowest (138% or less of the federal poverty level, FPL), low (139% to 250%), middle (251% to 400%), and high (above 400%). Spending patterns from 2012 to 2014 (pre-ACA) and 2014-2015 (post-ACA) were compared.

For the 84 431 adults included in the study, ACA was associated with 11.9%(95%CI, −17.1% to −6.4%; p < 0.001) decrease in mean out-of-pocket spending and 12.1% (95%CI, 1.9%-23.3%) increase in mean premium spending. The lowest income group had the greatest decrease in out-of-pocket spending (21.4% decrease, 95%CI, −30.1% to −11.5%; p < 0.001), while the highest income group had the greatest premium increase (22.9%; 95%CI, 5.5%-43.1%). The odds of high burden spending (>10% of total family income) decreased following the implementation of ACA (odds ratio [OR], 0.80; 95%CI, 0.70-0.90).

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