ACA Implementation Decreased Mean Out-of-Pocket Spending by 11.9%

Reduced out-of-pocket costs seen especially for lower-income groups; mean premium costs up overall
Reduced out-of-pocket costs seen especially for lower-income groups; mean premium costs up overall

HealthDay News — Implementation of the Affordable Care Act (ACA) was associated with reduced out-of-pocket spending, although increases were noted in mean premium spending, according to a study published online January 22 in JAMA Internal Medicine.

Anna L. Goldman, MD, MPA, from the Cambridge Health Alliance in Massachusetts, and colleagues used data from the Medical Expenditure Panel Survey to examine changes in out-of-pocket spending, premium contributions, and total health spending after the ACA's expansion of coverage on January 1, 2014. The study population included a sample of 83,431 U.S. adults aged 18 to 64 years. 

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The researchers found that ACA implementation was correlated with an 11.9% decrease in mean out-of-pocket spending in the full sample and with decreases of 21.4, 18.5, and 12.8% in the lowest-, low-, and middle-income groups, respectively. There was an increase in the mean premium spending in the full sample (12.1%) and the higher-income group (22.9%). In the lowest-income group only, the combined out-of-pocket plus premium spending decreased (−16%). In the full sample and the lowest-income group, the odds of household out-of-pocket spending exceeding 10% of family income decreased (odds ratios, 0.8 and 0.8, respectively). In the middle-income group there was an increase in the odds of high-burden premium spending (odds ratio, 1.28).

"Implementation of the ACA was associated with reduced out-of-pocket spending, particularly for low-income persons," the authors write. "Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans."

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