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Effects of Advanced Premium Tax Credits and Cost-Sharing Reductions on Health Care Utilization and Expenditures

预付保费税收抵免和费用分摊减少对医疗保健利用和支出的影响

基本信息

批准号：
9898368
负责人：
Amanda Honeycutt
金额：
$ 4.98万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2022-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9898368
关键词：
Effects Advanced Premium Tax Credits

项目摘要

PROJECT SUMMARY/ABSTRACT DESCRIPTION: See instructions. This must contain a summary of the proposed activity suitable for dissemination to the public (no proprietary/confidential information). It should be a self-contained description of the project and contain a statement of objectives and methods to be employed. It should be informative to other persons working in the same or related fields. DO NOT EXCEED THE SPACE PROVIDED. There is limited research on the effects of two distinct Patient Protection and Affordable Care Act (ACA) subsidies designed to incentivize the purchase of private health insurance: premium tax credits and cost- sharing reductions. The premium tax credits and cost-sharing subsidies are intended to reduce the price of obtaining insurance and medical care for low-income people who did not previously have access to affordable insurance coverage. People with incomes at 100% of the federal poverty level (FPL) gain eligibility for substantial premium tax credits and cost-sharing reductions, lose eligibility for cost-sharing reductions at 250% FPL, and lose eligibility for premium tax credits at 400% FPL. Little evidence exists on how low- income people's health care use and expenditures change in response to premium tax credits and cost- sharing reductions for private insurance. The proposed research will use a quasi-experimental design and an ideal data source, the Medical Expenditure Panel Survey, to investigate the effects of premium tax credits and cost-sharing reductions on health care utilization and expenditures. Aim 1 assesses changes in the types (i.e., any use) and intensity (i.e., counts of services) of health care use associated with different levels of eligibility for the ACA premium tax credits and cost-sharing reductions. By examining the observed patterns of health care utilization, Aim 2 assesses changes in medical expenditures and patient cost burden. This study directly informs two areas of focus for the Agency for Healthcare Research and Quality: (1) increase accessibility by evaluating ACA coverage expansions, and (2) improve health care affordability, efficiency, and cost transparency. The proposed research will address a significant knowledge gap by assessing the degree to which eligibility for the ACA premium tax credits and cost-sharing reductions separately affect health care use and expenditures among low-income consumers. It is critical to understand whether low-income people are using their insurance to obtain different types of medical care or change the volume of services to inform modifications to the ACA subsidies. The subsidies are intended to substantially reduce the out-of-pocket burden. This study will assess whether that aim is achieved. By comparing different levels of subsidies, the results will also be useful to policymakers to modify the subsidy structures within the 100% to 400% FPL range and potentially above 400% FPL. Many of the remaining uninsured fall below 400% of the FPL, and the results would allow for better forecasts of the budgetary, coverage, and health care use effects of expansions to the subsidies.

项目总结/摘要描述：参见说明。这必须包含一个适合向公众传播的拟议活动的摘要（没有专有/机密信息）。它应该是一个独立的项目描述，并包含一个目标和方法的声明，就业。它应该对在相同或相关领域工作的其他人提供信息。不要超过所提供的空间。有两个不同的病人保护和平价医疗法案（ACA）的影响有限的研究旨在激励购买私人医疗保险的补贴：保费税收抵免和成本- 分享削减。保费税收抵免和成本分摊补贴旨在降低为以前无法获得医疗服务的低收入者提供保险和医疗服务; 负担得起的保险。收入达到联邦贫困线（FPL）100%的人获得资格对于大量保费税收抵免和费用分摊减免， 250% FPL，并失去400% FPL的保费税收抵免资格。很少有证据表明- 收入人群医疗保健使用和支出会随着保费税收抵免和成本的变化而变化，分享私人保险的削减。拟议的研究将使用准实验设计和理想的数据来源，医疗支出小组调查，调查保费税收抵免的影响以及减少医疗保健利用和支出的费用分摊。目标1评估了类型（即，任何用途）和强度（即，与不同水平相关的卫生保健使用的服务计数有资格获得ACA保费税收抵免和费用分摊减免。通过检查观察到的医疗保健利用模式，目标2评估医疗支出和病人费用负担的变化。这项研究直接告知了医疗保健研究和质量机构的两个重点领域：（1）通过评估ACA覆盖范围的扩大来提高可及性，以及（2）提高医疗保健的负担能力，效率和成本透明度。拟议的研究将通过以下方式解决重大的知识差距：评估ACA保费税收抵免和费用分摊减少的资格程度分别影响低收入消费者的医疗保健使用和支出。我们需要了解低收入人群是否正在使用他们的保险来获得不同类型的医疗保健，或者改变他们的医疗保险。服务量，以通知修改ACA补贴。补贴的目的是要大大减轻自付负担。本研究将评估这一目标是否实现。通过比较不同补贴水平，其结果也将有助于政策制定者修改补贴结构， 100%至400% FPL范围，可能高于400% FPL。剩下的许多没有保险的人 400%的FPL，结果将允许更好地预测预算，覆盖面和健康扩大对补贴的照顾使用效果。