MedicalResearch: What is the background for this study?
Dr. Hill: The Affordable Care Act offers two major ways to extend health coverage to more Americans: through expanding state Medicaid programs and through the Marketplace. States can expand Medicaid coverage to adults with family incomes at or below 138 percent of the federal poverty guidelines (approximately $16,242 for an individual and $33,465 for a family of four in 2015).
At the time of the study, 23 states had not yet expanded their Medicaid programs. In those states, poor adults typically continue to have very limited access to Medicaid. However, adults with incomes at or above the poverty guidelines who lack access to affordable insurance elsewhere are eligible for premium tax credits in the Marketplace. If these low-income adults purchase silver plans, then they are also generally eligible for cost sharing reductions.
MedicalResearch: What was the methodology for study?
Dr. Hill: The study used data from then Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) to determine family out-of-pocket health care spending in 2005 – 2010 for uninsured, low-income adults who lived in the states that had not yet expanded Medicaid under the Affordable Care Act at the time of the study. The study focused on those who would have been eligible for Medicaid if their states expanded eligibility (income at or below 138 percent of poverty guideline), and whose incomes were high enough to be eligible for premium tax credits and cost sharing reductions through the Health Insurance Marketplace (at or above poverty guidelines). The study then compared those data with the following simulated scenarios for these adults: coverage in a Marketplace silver plan with financial assistance; and enrolling in expanded Medicaid.
MedicalResearch: What are the main findings?
Dr. Hill: Under a Marketplace silver plan, for these adults, average family out-of-pocket health care spending would have been $1,948 per year, while under Medicaid, family out-of-pocket health care spending would have averaged $938 a year. Thus, enrolling in Medicaid would have saved these adults’ families approximately $1,000 per year, on average, compared with a Marketplace silver plan. The term “out-of-pocket” refers to all health care expenditures that an individual has to pay himself or herself, that are not covered by his or her health plan. These include co-pays, coinsurance, deductibles, and out-of-pocket premiums.
The study also estimated that the percentage of adults in families with out-of-pocket costs exceeding 10 percent or 20 percent of income would be reduced if low-income adults were able to enroll in Medicaid rather than get coverage in a Marketplace silver plan with premium tax credits and cost sharing reductions (6.0 percent vs. 17.1 percent and 0.9 percent vs. 3.7 percent, respectively). Thus, the proportion of family income spent on out-of-pocket costs for health care and premiums in those states would be reduced if Medicaid were expanded.
- What recommendations do you have for future research as a result of this study?
Dr. Hill: Additional research is needed not only on out-of-pocket cost differences between the Marketplaces and Medicaid, but also on differences in access to care and health impacts.
MedicalResearch.com Interview with:, Steven C. Hill, PhD, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, & Rockville, MD 20850 (2015). Study shows families could save more than $1,000 on average if states expanded Medicaid. MedicalResearch.com