Medicaid Versus Marketplace Coverage For Near-Poor Adults: Effects On Out-Of-Pocket Spending And Coverage
Medicaid Versus Marketplace Coverage For Near-Poor Adults: Effects On Out-Of-Pocket Spending And Coverage
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DOI：
10.1377/hlthaff.2017.1166
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发表时间：
2018-02-01
期刊：
影响因子：
9.7
通讯作者：
Sommers, Benjamin D.
中科院分区：
文献类型：
--
作者：
Blavin, Fredric;Karpman, Michael;Sommers, Benjamin D.
在根据《平价医疗法案》扩大医疗补助资格的州，非老年近贫困成年人--家庭收入为联邦贫困水平的100- 138%的人--通常有资格获得医疗补助，没有保费，费用分摊最低。在没有扩大资格的州，这些成年人可能有资格获得保费税收抵免，以购买具有自付保费和费用分摊要求的市场计划。我们使用2010-15年的数据来估计医疗补助扩大对覆盖范围和自付费用的影响，并与市场覆盖范围的影响进行比较。对于家庭收入为贫困的100- 138%的成年人来说，生活在医疗补助扩张状态下，没有保险的可能性降低了4.5个百分点，平均总自付支出下降了344美元，高自付支出负担下降了4.1个百分点。（也就是说，支出超过收入的10%），并且相对于生活在非扩张状态，自付支出的概率下降了7.7个百分点。这些研究结果表明，用医疗补助资格取代市场的政策可能会降低覆盖率，并增加注册者的自付费用。
In states that expanded Medicaid eligibility under the Affordable Care Act, nonelderly near-poor adults-those with family incomes of 100-138 percent of the federal poverty level-are generally eligible for Medicaid, with no premiums and minimal cost sharing. In states that did not expand eligibility, these adults may qualify for premium tax credits to purchase Marketplace plans that have out-of-pocket premiums and cost-sharing requirements. We used data for 2010-15 to estimate the effects of Medicaid expansion on coverage and out-of-pocket expenses, compared to the effects of Marketplace coverage. For adults with family incomes of 100-138 percent of poverty, living in a Medicaid expansion state was associated with a 4.5-percentage-point reduction in the probability of being uninsured, a $344 decline in average total out-of-pocket spending, a 4.1-percentage-point decline in high out-of-pocket spending burden (that is, spending more than 10 percent of income), and a 7.7-percentage-point decline in the probability of having any out-of-pocket spending relative to living in a nonexpansion state. These findings suggest that policies that substitute Marketplace for Medicaid eligibility could lower coverage rates and increase out-of-pocket expenses for enrollees.