Since 2014, when the Affordable Care Act’s health insurance marketplaces opened and many states expanded Medicaid eligibility under the law, the rate of growth in out-of-pocket health care spending has slowed and fewer Americans report medical bill problems. While Medicaid coverage unambiguously lowers premiums and out-of-pocket costs for enrollees, it’s less certain that marketplace enrollees also experience reduced medical spending.
In a new Commonwealth Fund brief, New York University’s Sherry Glied and colleagues examine how out-of-pocket cost-sharing expenses and spending on premiums changed between 2013 and 2014 for people with incomes above the Medicaid eligibility threshold. They find that the net effect of the ACA’s marketplace insurance subsidies, reduced cost-sharing, out-of-pocket limits, and other insurer regulations has been to reduce the number of people facing substantial costs for their health care.
