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ACA Lowered Out-of-Pocket Costs for Low-Income Families

High-income families saw smaller financial benefit from ACA policies than low-, middle-income families

couple paying bills

TUESDAY, Oct. 13, 2020 (HealthDay News) -- Low- and middle-income families experienced a larger reduction in out-of-pocket (OOP) costs after initiation of the Affordable Care Act (ACA) than higher-income families, according to a study published online Sept. 28 in JAMA Pediatrics.

Lauren E. Wisk, Ph.D., from University of California, Los Angeles, and colleagues examined changes in health care-related financial burden for U.S. families with children before and after the ACA was implemented. The analysis included data from 92,165 families participating in the Medical Expenditure Panel Survey (2000 to 2017). Families were categorized by income-based ACA eligibility (≤138 percent [lowest-income], 139 to 250 percent [low-income], 251 to 400 percent [middle-income], and >400 percent [high-income] of the federal poverty level).

The researchers found that compared with high-income families (high OOP burden, 1.1 percent pre-ACA versus 0.9 percent post-ACA), the lowest-income families saw the greatest reduction in high OOP burden (35.6 percent pre-ACA versus 23.7 percent post-ACA). While premiums rose for all groups, premium unaffordability was worsened least for the lowest-, low-, and middle-income families versus higher-income families.

"Although many ACA policies were adult focused, low- and middle-income families with children have benefited from reduced financial burden, but the amount of financial hardship post-ACA implementation remains substantial," the authors write.

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