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

项目摘要/摘要 说明：请参阅说明。它必须包含适合向公众传播的拟议活动的摘要(否 专有/机密信息)。它应该是对项目的独立描述，并包含对目标和方法的声明 受雇的。它应该为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。 关于两项截然不同的患者保护和平价医疗法案(ACA)的影响的研究有限 旨在激励购买私人健康保险的补贴：保费税收抵免和成本- 共享减量。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 负担得起的保险覆盖范围。收入达到联邦贫困水平(FPL)100%的人获得资格 对于大量的保费税收抵免和成本分担减免，在以下情况下失去成本分担减免的资格 250%的FFP，并失去400%FFP的保费税收抵免资格。几乎没有证据表明- 收入人群的医疗保健使用和支出随着保费税收抵免和成本的变化而变化- 分享私人保险的减免额。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，以调查保费税收抵免的影响 以及减少卫生保健利用和支出的费用分担。AIM 1评估了 与不同级别相关的卫生保健使用的类型(即任何用途)和强度(即服务数量) 是否有资格享受ACA保费税收抵免和成本分担减免。通过检查观察到的 卫生保健利用模式，目标2评估医疗支出和患者费用负担的变化。 这项研究直接为医疗研究和质量机构提供了两个重点领域：(1) 通过评估ACA覆盖范围的扩大来增加可获得性，以及(2)提高卫生保健的可负担性， 效率和成本透明度。拟议的研究将通过以下方式解决一个重大的知识差距 评估获得ACA保费税收抵免和成本分担减免的资格程度 分别影响低收入消费者的医疗保健使用和支出。理解这一点很重要 无论低收入者是用他们的保险来获得不同类型的医疗服务，还是改变 通知修改ACA补贴的服务量。这些补贴的目的是大幅提高 减少自掏腰包负担。这项研究将评估是否实现了这一目标。通过比较不同的 补贴水平，结果也将有助于政策制定者修改补贴结构 100%至400%fpl范围，并可能超过400%fpl。剩下的许多没有保险的人都属于以下类别 的400%，结果将允许更好地预测预算、覆盖范围和健康状况 关爱利用扩大对补贴的影响。

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.