Abstract
IntroductionUnder the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments.MethodsWe conducted face to face surveys in four languages with a convenience sample of 976 patients seeking care at three hospital emergency departments five years after Massachusetts reform. We compared perceived affordability of insurance, financial burden, and satisfaction among low cost sharing plan recipients (recipients of Medicaid and insurance exchange-based plans with minimal cost-sharing and no premiums), high cost sharing plan recipients (recipients of exchange-based plans that required cost-sharing and premium payments) and the commercially insured.ResultsWe found that despite having higher incomes, higher cost-sharing plan recipients were less satisfied with their insurance plans and perceived more difficulty affording their insurance than those with low cost-sharing plans. Higher cost-sharing plan recipients also reported more difficulty affording medical and non-medical health care as well as insurance premiums than those with commercial insurance. In contrast, patients with low cost-sharing public plans reported higher plan satisfaction and less financial concern than the commercially insured.ConclusionsPolicy makers with responsibility for the benefit design of public insurance available under health care reforms in the U.S. should calibrate cost-sharing to income level so as to minimize difficulty affording care and financial burdens.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0235-2) contains supplementary material, which is available to authorized users.
Highlights
Under the Massachusetts health reform, low income residents were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums
No previous research has examined whether perceived affordability of health care or financial burdens varies among enrollees in the low versus higher cost-sharing public plans that formed the backbone of the Affordable Care Act (ACA) insurance expansion
A higher proportion of high cost-sharing public plans (CSP) recipients reported perceived affordability barriers to medical care as compared to patients with low CSP, though this was of borderline significance (33 % vs. 21 %, respectively, p = 0.05)
Summary
Under the Massachusetts health reform, low income residents (those with incomes below 150 % of the Federal Poverty Level [FPL]) were eligible for Medicaid and health insurance exchange-based plans with minimal cost-sharing and no premiums. Those with slightly higher incomes (150 %-300 % FPL) were eligible for exchange-based plans that required cost-sharing and premium payments. No previous research has examined whether perceived affordability of health care or financial burdens varies among enrollees in the low versus higher cost-sharing public plans that formed the backbone of the ACA insurance expansion. The Massachusetts health reform, which shared most key features of the ACA, was fully implemented by 2008 and provides an opportunity to examine these questions in the setting of a comparable but more mature reform
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
