Many Americans saw decreased out-of-pocket medical expenses after implementation of the ACA, but not necessarily reduced premiums, according to a study published in JAMA Internal Medicine.
For the study, researchers from Boston-based Harvard Medical School and New York City-based City University of New York at Hunter College examined Medical Expenditure Panel Survey data from Jan. 1, 2012, through Dec. 31, 2015. The study involved 83,431 adults age 18 to 64 and 49,197 households. Researchers considered 2012 and 2013 pre-ACA and 2014 and 2015 post-ACA.
The study found an 11.9 percent decrease in mean out-of-pocket healthcare spending, from $619.23 pre-ACA to $548.48, post-ACA. This decrease was attributed to various factors, such as Medicaid expansion, cost-sharing and premium subsidies on the ACA exchanges.
Among individual income groups, the lowest-income group (up to 138 percent of the federal poverty level) saw a 21.4 percent decrease in mean out-of-pocket healthcare spending post-ACA, while the low-income group (earning 139 percent to 250 percent of the federal poverty level) saw an 18.5 percent decrease. Americans in the middle-income group (251 percent to 400 percent of the federal poverty level) saw an 18.5 percent decrease, according to the study. Researchers did not see a significant decrease in out-of-pocket healthcare spending for the higher-income group (above 400 percent of the federal poverty level).
While mean out-of-pocket healthcare spending decreased post-ACA, mean premium spending increased 12.1 percent among all study participants and 22.9 percent among the higher-income group post-ACA, according to the study. Researchers said out-of-pocket and premium healthcare spending combined decreased 16 percent in the lowest-income group but did not decrease overall among study participants or in other income groups.
"Implementation of the ACA was associated with reduced out-of-pocket spending, particularly for low-income persons. However, many of these individuals continue to experience high-burden out-of-pocket and premium spending. Repeal or substantial reversal of the ACA would especially harm poor and low-income Americans," the study's authors concluded.
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