The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures

This article considers the extent to which Affordable Care Act state Medicaid expansions alleviated the burden of out-of-pocket costs associated with obtaining health insurance and medical care using data from the 2011 to 2016 Current Population Survey Annual Social and Economic Supplement. Using a difference-in-differences framework, the analysis examines effects of the Medicaid expansions on out-of-pocket expenditures for health insurance premiums and medical care, comparing expenditures across expansion and nonexpansion states before and after the expansions were implemented, performing separate analyses for individuals with family income at various eligibility cutoff levels in the first and second years of expansion implementation. The findings suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals. These findings suggest that the expansions were effective in reducing medical out-of-pocket expenditures.