Liu Charles, Gotanda Hiroshi, Khullar Dhruv, Rice Thomas, Tsugawa Yusuke
Charles Liu (
Hiroshi Gotanda is an assistant professor of medicine at Cedars-Sinai Medical Center, in Los Angeles, California.
Health Aff (Millwood). 2021 Mar;40(3):496-504. doi: 10.1377/hlthaff.2020.01106.
Research suggests that the Affordable Care Act (ACA) Medicaid expansions improved financial protection for the poor. However, evidence is limited on whether subsidies offered through the ACA Marketplaces, the law's other major coverage expansion, were associated with reduced financial burden. Using national survey data from the period 2008-17, we examined changes in household health care spending among low-income adults eligible for both Marketplace premium subsidies and cost-sharing reductions (139-250 percent of the federal poverty level) and middle-income adults eligible only for premium subsidies (251-400 percent of the federal poverty level), using high-income adults ineligible for subsidies (greater than 400 percent of the federal poverty level) as controls. Among low-income adults, Marketplace subsidy implementation was associated with 17 percent lower out-of-pocket spending and 30 percent lower probability of catastrophic health expenditures. In contrast, middle-income adults did not experience reduced financial burden by either measure. These findings highlight the successes and limitations of Marketplace subsidies as debate continues over the ACA's future.
研究表明，《平价医疗法案》（ACA）的医疗补助计划扩展改善了对贫困人口的经济保护。然而，关于该法案的另一项主要覆盖范围扩展——通过ACA市场提供的补贴是否减轻了经济负担，相关证据有限。利用2008年至2017年期间的全国调查数据，我们研究了符合市场保费补贴和费用分摊减免条件的低收入成年人（联邦贫困线的139%至250%）以及仅符合保费补贴条件的中等收入成年人（联邦贫困线的251%至400%）家庭医疗支出的变化，以不符合补贴条件的高收入成年人（超过联邦贫困线的400%）作为对照。在低收入成年人中，市场补贴的实施使自付支出降低了17%，灾难性医疗支出的概率降低了30%。相比之下，中等收入成年人在这两项指标上均未减轻经济负担。随着对ACA未来的争论持续不断，这些发现凸显了市场补贴的成功之处和局限性。
