ArticleBMJ (Clinical research ed.)2020
Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study.
Article in BMJ (Clinical research ed.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
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Who cites it
38 citing papers in PubMed.
- Socioeconomic disparities in access to care and healthcare expenditures among U.S. adults: evidence from the Medical Expenditure Panel Survey, 2018-2022.Annals of medicine and surgery (2012) · 2026Article
- Medical debt, financial risk factors, and deferred care among low-wage workers.Health affairs scholar · 2025Article
- Employment Disruption and Financial Burden Associated with Gastrointestinal Cancers.Annals of surgical oncology · 2025Article
- Examining the Impact of ACA Medicaid Expansion on Insurance Coverage, Access to Care and Health of Low-Income Parents.Health services research · 2025Article
- Strengthening financial protection through multitiered health coverage: evidence from 667 055 low-income households in China.BMJ global health · 2025Article
- Patient healthcare spending after the No Surprises Act: quasi-experimental difference-in-differences study.BMJ (Clinical research ed.) · 2025Article
- Medicaid Expansion Among Nonelderly Adults and Cardiovascular Disease: Efficiency Vs. Equity.The Milbank quarterly · 2025Article
- Loss of Pregnancy-Related Medicaid Coverage Is Associated With Unmet Need for Health Care, Medical Financial Hardship, and Lower Health Care Use in Postpartum Women.Public health challenges · 2025Article
- The social determinants of resilience: A conceptual framework to integrate psychological and policy research.The American psychologist · 2024Article
- The Affordable Care Act and income-based disparities in health care coverage and spending among nonelderly adults with cancer.Health affairs scholar · 2024Article
- The impact of the implementation of a national policy on dementia on healthcare costs in older patients with dementia in Korea: a quasi-experimental difference-in-difference study.The Lancet regional health. Western Pacific · 2024Article
- Heterogeneity within the Oregon Health Insurance Experiment: An application of causal forests.PloS one · 2024Article
- Effects of the affordable care Act's Medicaid expansion on health insurance coverage for individuals in same-sex couples.Health services research · 2023Article
- Catastrophic Health Care Expenditure Following Brachial Plexus Injury.The Journal of hand surgery · 2023Article
- Which indicator should be used? A comparison between the incidence and intensity of catastrophic health expenditure: using difference-in-difference analysis.Health economics review · 2022Article
- A Journey Undertaken by Families to Access General Surgical Care for their Children at Muhimbili National Hospital, Tanzania; Prospective Observational Cohort Study.World journal of surgery · 2022Observational
- Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016.JAMA network open · 2022Article
- Change in Gender on Record and Transgender Adults' Mental or Behavioral Health.American journal of preventive medicine · 2022Article
- Catastrophic health expenditures, insurance churn, and nonemployment among gynecologic cancer patients in the United States.American journal of obstetrics and gynecology · 2022Article
- Improvements and Gaps in Financial Risk Protection Among Veterans Following the Affordable Care Act.Journal of general internal medicine · 2022Article
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4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine 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).
designQuasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions.
settingUnited States.
participantsA nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES: Four annual healthcare spending outcomes: 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). P values were adjusted for multiple comparisons.
results37 819 adults were included in the study. 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% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions.
conclusionMedicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.
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