Table 2.
Change in spending outcomes and catastrophic financial burden after Affordable Care Act Medicaid expansions*
| Outcome | Years 2014-15 (implementation period) | Years 2016-17 (long term follow-up period) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Difference-in-difference estimate (95% CI)† | P value | Difference-in-difference estimate (95% CI)† | P value | ||||||||
| Relative percentage change (%) |
Absolute change‡ |
Unadjusted | Adjusted § | Relative percentage change (%) |
Absolute change‡ |
Unadjusted | Adjusted § | ||||
| Out-of-pocket spending¶ | −19.1 (−34.6 to 0.0) | −$83 (−$158 to −$7) | 0.05 | 0.05 | −28.0 (−38.4 to −15.8) | −$122 (−$178 to −$67) | <0.001 | <0.001 | |||
| Premium contributions** | −14.3 (−37.8 to 17.9) |
−$114 (−$345 to $117) |
0.34 | 0.34 | −23.2 (−46.7 to 10.6) |
−$187 (−$425 to $52) |
0.16 | 0.31 | |||
| Out-of-pocket plus premium spending** | −15.0 (−29.3 to 2.2) |
−$225 (−$468 to $19) |
0.08 | 0.08 | −29.0 (−40.5 to −15.3) |
−$442 (−$650 to −$234) |
<0.001 | <0.001 | |||
| Catastrophic financial burden, percentage points†† | 1.0 (−2.5 to 4.5) | 0.56 | 0.56 | −4.7 (−7.9 to −1.4) | 0.006 | 0.01 | |||||
1=£0.77; €0.90.
Values are weighted to be nationally representative of individuals aged 19-64 years with family incomes lower than 138% of the federal poverty level based on the pooled data of Medical Expenditure Panel Survey 2010-13. US dollars are adjusted for inflation to 2017 using the consumer price index.
Adjusted for age, sex, race/ethnicity, education, employment, marital status, family size, number of children, and family incomes (for spending outcomes only) as well as specific fixed effects for state and year.
Estimated using average marginal effects. See the main text for details.
Adjusted for multiple comparisons using the Benjamini-Hochberg method.
Out-of-pocket spending includes deductibles, copayments, and coinsurance paid by each individual.
Family level premium contributions were assigned to each individual in the family. Similarly, family level out-of-pocket plus premium spending were calculated by summing out-of-pocket spending paid by all family members and family level premium contributions, and then assigning the value to each member of the family.
Defined as annual out-of-pocket plus premium spending exceeding 40% of post-subsistence income. Data are percentage point changes rather than relative/absolute changes.