Out-of-Pocket Spending and Financial Burden Among Low Income Adults After Medicaid Expansions in the United States: Quasi-Experimental Difference-in-Difference Study (The BMJ)

​Study focus: The association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17).

Participants: 37,819 low income adults (family income below 138% of the federal poverty level), ages 19 to 64, after Medicaid expansions using the 2010-17 Medical Expenditure Panel Survey.

Outcomes studied: Out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income).

Findings: Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change −28.0%; adjusted absolute change −$122); lower out-of-pocket plus premium spending (adjusted percentage change −29.0%; adjusted absolute change −$442); and lower probability of experiencing a catastrophic financial burden in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions.

Read the Publication: 

• Journal Article: Out-of-Pocket Spending and Financial Burden Among Low Income Adults After Medicaid Expansions in the United States: Quasi-Experimental Difference-in-Difference Study