Glied Sherry, Chakraborty Ougni, Russo Therese
Robert F. Wagner School of Public Services, New York University.
Central Office of Diversity and Inclusion, New York City Health +Hospitals.
Issue Brief (Commonw Fund). 2017 Aug;2017:1-9.
ISSUE. Prior research shows that low-income residents of states that expanded Medicaid under the Affordable Care Act are less likely to experience financial barriers to health care access, but the impact on out-of-pocket spending has not yet been measured. GOAL. Assess how the Medicaid expansion affected out-of-pocket health care spending for low-income families compared to those in states that did not expand and consider whether effects differed in states that expanded under conventional Medicaid rules vs. waiver programs. METHODS. Analysis of the Consumer Expenditure Survey 2010–2015. KEY FINDINGS AND CONCLUSIONS. Compared to families in nonexpansion states, low-income families in states that did expand Medicaid saved an average of $382 in annual spending on health care. In these states, low-income families were less like to report any out-of-pocket spending on insurance premiums or medical care than were similar families in nonexpansion states. For families that did have some out-of-pocket spending, spending levels were lower in states that expanded Medicaid. Low-income families in Medicaid expansion states were also much less likely to have catastrophically high spending levels. The form of coverage expansion — conventional Medicaid or waiver rules — did not have a statistically significant effect on these outcomes.
问题。先前的研究表明，根据《平价医疗法案》扩大医疗补助计划的州的低收入居民在获得医疗保健方面遇到经济障碍的可能性较小，但对自付费用的影响尚未得到衡量。目标。评估与未扩大医疗补助计划的州相比，医疗补助计划的扩大对低收入家庭自付医疗费用的影响，并考虑在按照传统医疗补助规则扩大的州与豁免计划州中影响是否存在差异。方法。对2010 - 2015年消费者支出调查进行分析。主要发现与结论。与未扩大医疗补助计划的州的家庭相比，扩大了医疗补助计划的州的低收入家庭每年在医疗保健方面平均节省382美元。在这些州，与未扩大医疗补助计划的州的类似家庭相比，低收入家庭报告支付保险费或医疗费用的自付费用的可能性较小。对于确实有一些自付费用的家庭，在扩大了医疗补助计划的州支出水平较低。医疗补助计划扩大州的低收入家庭出现灾难性高支出水平的可能性也小得多。覆盖范围扩大的形式（传统医疗补助或豁免规则）对这些结果没有统计学上的显著影响。
