Medicaid may be a better financial and coverage option for low-income adults compared to an ACA marketplace plan, according to a study published in Health Affairs.
For the study, researchers examined out-of-pocket spending levels and coverage in 2010-15 using data from the Census Bureau's Current Population Survey and the American Community Survey. Their goal was to compare the effects of Medicaid expansion and ACA exchanges on coverage rates and out-of-pocket costs. They limited their analyses to 44 states and nonelderly near-poor adults with family incomes of 100 percent to 138 percent of the federal poverty level.
The study found people in Medicaid expansion states were 4.5 percent less likely to be uninsured compared to nonexpansion states. Average total out-of-pocket spending also decreased by $42 in Medicaid expansion states, according to the study. It was $1,014 in 2010–13 and fell to $972 in 2014–15. The study found average total out-of-pocket spending increased by $326 over the same time period in nonexpansion states. Average total out-of-pocket spending overall decreased by $344 due to Medicaid expansion.
Additionally, researchers said Medicaid expansion, relative to marketplace coverage, led to a 4.1 percent decrease in the amount of people with out-of-pocket spending more than 10 percent of income, and people in Medicaid expansion states were 7.7 percent less likely to have any out-of-pocket spending.
"These findings suggest that policies that substitute marketplace for Medicaid eligibility could lower coverage rates and increase out-of-pocket expenses for enrollees," the study's authors concluded.
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