平价医疗法案下的既往疾病保护：保险覆盖范围、保费缴纳和自付费用的变化。
Preexisting Condition Protections Under the Affordable Care Act: Changes in Insurance Coverage, Premium Contributions, and Out-of-Pocket Spending.
机构信息
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA.
出版信息
Value Health. 2022 Aug;25(8):1360-1370. doi: 10.1016/j.jval.2022.01.016. Epub 2022 Mar 15.
OBJECTIVES
In January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA.
METHODS
We identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level [FPL]; middle 139%-400% FPL; and high > 400 FPL).
RESULTS
The ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences -$279; 95% confidence interval -$528 to -$29).
CONCLUSIONS
The ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions.
目的
2014 年 1 月，平价医疗法案（ACA）的既往疾病保护条款禁止基于既往疾病拒保、保费上涨和理赔拒绝。本研究旨在调查在 ACA 实施既往疾病保护后，覆盖范围和保费以及自付支出的变化。
方法
我们从 2011-2013 年和 2015-2017 年医疗支出面板调查中确定了有（n=59041）和没有既往疾病（n=61970）的 18-64 岁成年人。我们使用差分差异和差分差分差异方法评估了既往疾病保护与 ACA 后保险覆盖、保费贡献和自付支出变化之间的关联。简单和多变量逻辑或多变量两部分模型适用于全样本，并按家庭收入（低≤138%联邦贫困水平[FPL]；中 139%-400%FPL；高>400 FPL）进行分层。
结果
ACA 在所有收入水平上，对有或没有既往疾病的个人，非团体保险的覆盖范围都有所增加。我们发现，无论既往疾病状况是否可拒保，非团体私人保险的家庭保费贡献都有下降，但团体保险的家庭保费贡献没有显著变化。我们发现，在有或没有既往疾病的个人中，有既往疾病的个人自付支出的降幅大于没有既往疾病的个人，在非团体保险覆盖的个人中，这种差异更大（差异差异差异-279 美元；95%置信区间-528 美元至-29 美元）。
结论
ACA 的保护措施与有既往疾病的成年人自付支出的减少有关。
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