Research Update: Affordability and Economic Security Thanks to Medicaid

CCF’s last research update focused on families’ increase in economic security after the Medicaid expansion. This week, I would like to build on the research presented last time. Below are two additional studies that examine links between affordable, comprehensive health care and financial security. And of course, the role of Medicaid in it all.

Health Affairs: Sustained Gains In Coverage, Access, And Affordability Under The ACA: A 2017 Update

This study examines the gains in health insurance coverage, access, and affordability as a result of the ACA using the latest data from the Urban Institute’s 2017 Health Reform Monitoring Survey.  

What it finds

  • Adults who live in non-expansion states are significantly more likely to report an unmet need for health care due to cost and problems paying family medical bills.
  • They are also significantly more likely to be uninsured, not have a usual source of care, and not have a routine check-up in the past year.

Why it matters

  • The study’s findings show that adults all across the country benefitted from the increase in coverage as a result of the ACA.
  • Improvements in affordability were particularly pronounced for individuals with low and moderate incomes living in expansion states, as shown in the chart below.

Insurance Coverage and Health Care Access

The Commonwealth Fund: How Well Does Insurance Coverage Protect Consumers from Health Care Costs?

This brief examines “underinsurance” among adults, which the authors define as:

  1. Out of pocket costs (excluding premiums) over the last 12 months equal to 10% or more of household income or 5% or more if your income is below 200% FPL.
  2. A deductible that is 5% or more of household income.

What it finds

  • More than one quarter of insured adults were underinsured in 2016. Florida and Texas, two large non-expansion states, had the highest share of underinsured adults.
  • When the results were broken out by coverage type, the percent of underinsured varied: 24% of adults with ESI, 26% of adults with Medicaid, 44% of adults with Marketplace or other individual market coverage, and 47% of adults with Medicare.
  • The authors note that Medicaid requires little cost sharing, but because adults in the program have very low incomes, even very small out of pocket costs can add up to a large share of income.
  • Deductibles in private insurance are a barrier to care and lead to financial insecurity.

Why it matters

  • Underinsured adults are more susceptible to financial insecurity. More than half of underinsured adults reported problems paying medical bills or have medical debt. Of these adults:
    • 47% said they used up all their savings to pay medical bills
    • 40% said they received a lower credit rating because of medical bills
    • 38% said they accrued credit card debt to pay medical bills
    • 10% said they took out a mortgage against their home or another loan
    • 6% said they declared bankruptcy
  • As a result of financial hardship, underinsured adults were more than twice as likely to report not getting needed care due to cost, not going to the doctor when sick, not filling a prescription, skipping a test or treatment, and not seeing a specialist compared to adults who were not underinsured.
  • Expanding Medicaid in a state can contribute to fewer adults being underinsured (and fewer adults being uninsured), leading families to have access to more affordable health care and an improved financial outlook.

Find more Research Updates here.

Karina Wagnerman
Karina Wagnerman is a Senior Health Policy Analyst at the Center for Children and Families

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