Ruscitti Brielle, Kern Caroline, Bowser Diana
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA.
Health Serv Insights. 2024 Dec 3;17:11786329241304618. doi: 10.1177/11786329241304618. eCollection 2024.
The Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions.
Compare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs.
Descriptive Cost Analysis.
Using Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using -tests.
The findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients.
Despite the ACA's success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.
《平价医疗法案》（ACA）旨在扩大医保覆盖范围并增加获得医疗保险的机会。尽管参保人数有所增加，但对于医保覆盖范围和医疗服务是否可负担仍存在诸多担忧。先前的研究表明，人们越来越担心保费上涨和成本分担，包括免赔额，尤其是对于患有慢性病的人。
比较17个州针对不同糖尿病参与情况及相关医疗需求的个体的ACA市场计划可用性和成本。
描述性成本分析。
利用Healthcare.gov各州的个人市场网站，我们采用描述性成本分析来比较一名63岁个体的计划可用性和保费、免赔额、共付额及共保的成本，该个体在城市和农村地区分别为非糖尿病患者、高参与度糖尿病患者或低参与度糖尿病患者。使用第二低月保费的银色计划（基准计划），我们计算了这些个体情况的年度保费、共保、共付额和免赔额成本。我们使用t检验评估城乡地区内部和之间医疗保健组成部分成本的统计差异。
研究结果表明，在州内和州际，糖尿病患者，尤其是低参与度糖尿病患者，在超出保费的额外医疗保健成本上花费的收入比例明显高于非糖尿病患者。在一些州，低参与度糖尿病患者的花费比高参与度糖尿病患者高出3倍以上，凸显了额外的成本负担。对于低参与度糖尿病患者，免赔额推动了医疗保健支出，平均59%的医疗保健支出来自免赔额支付。结果未显示城乡糖尿病患者的成本在统计学上有差异。
尽管ACA取得了成功，但研究结果凸显了各州计划可用性的差异，以及中等收入个体承担的不成比例的成本负担，特别是与免赔额以及慢性病患者的共付额有关。
