Table 4.

Key references related to the financial burden of cost-sharing in low-income populations

AUTHOR(S)	POPULATION	METHODS	MAJOR FINDINGS
Artiga et al., 2006	Low income newly-covered Utah Medicaid beneficiaries in a limited program and existing enrollees who experienced increased cost-sharing in 2002, age 21–64	Descriptive study using data from telephone survey of a representative random sample (N=737) of beneficiaries	A large majority of both groups reported difficulty paying for at least one major category of basic needs Negative effects of medical expenses were largest among adults in the limited coverage program
Briesacher et al., 2009	Adults age 51+ with incomes below 100% FPL and/or who are Medicaid beneficiaries	Descriptive comparison of spending patterns of low-income adults using spending data from the Health and Retirement Study, longitudinal panel survey since 1992	Those with Medicaid allocated a larger share of their total resources (85%) to basic living expenses than did similar households without Medicaid Medication costs accounted for the largest proportion of health care expenses After paying for basic needs and health care costs, households had an average of $16 left each week
Selden et al., 2009	Low-income families (N=7,885, 80% <150% FPL) with publicly insured children	Descriptive study using MEPS data from 2003–2004; authors developed various cost-sharing scenarios and estimated presence of high financial burden (defined as >10% of disposable income spent on health care costs)	Because of other family health care spending, in zero cost-sharing scenario prevalence of high burden is 12.7% in families with publicly insured children Increased prevalence of high financial burden in these families (21.5%) in lowest cost-sharing scenarios, while the highest scenario increased prevalence to 27.7% Prevalence of high financial burden was highest in the poorest families (those at <100% of FPL)
Solotaroff et al., 2005	Oregon Health Plan Medicaid beneficiaries age 19–64 affected by increased cost-sharing in 2003	Descriptive analysis of mailed survey sent to stratified random sample of adults (n=1,374) affected by change in OHP Standard Plan	Substantial percentages (from a quarter to almost half depending on the subgroup) reported inability to meet food budgets because of medical expenses Chronically ill were significantly more likely than others to report difficulties in balancing medical care costs with other needs