ACA Reduced Out-of-Pocket Spending, Study Finds

A study published in JAMA Internal Medicine found that the implementation of the Affordable Care Act (ACA) was associated with reduced out-of-pocket spending, although mean premium spending increased.

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

Implementation of the ACA was associated with an 11.9-percent decrease in mean out-of-pocket spending in the full sample. These decreases were largest for the lowest-income cohorts (21.4%), followed by the low- and middle-income cohorts (18.5% and 12.8 %, respectively).

“However, many of these individuals continue to experience high-burden out-of-pocket and premium spending,” the authors concluded. “Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans.”

Mean premium spending increased 12.1 percent in the full sample and rose most sharply in the higher-income group (22.9%). In the lowest-income group, the combined out-of-pocket plus premium spending decreased (–16%).

In the full sample and the lowest-income group, the odds of a household spending more than 10 percent of the family income in out-of-pocket costs decreased (odds ratios [OR] = 0.8 for each). In the middle-income group, there was an increase in the odds of high-burden premium spending (OR=1.28).

Sources: Physician’s Briefing, January 23, 2018; Goldman AL, Woolhandler S, Himmelstein DU, et al. Out-of-pocket spending and premium contributions after implementation of the Affordable Care Act. JAMA Intern Med. 2018 January 22. [Epub ahead of print]