Who Is Paying for Us Now? Effect of Insurance Coverage on the Financial Burden of Healthcare (Pre and Post Implementation of Affordable Care Act)

Abstract

Purpose - This study is to estimate the association between health insurance coverage (public and private) and the financial burden of healthcare in the US across two time periods i.e. pre-and post enactment or implementation of the Affordable Care Act (ACA) of 2010. Methods: Observational data from the Medical Expenditure Panel Survey (nationally representative 23 household survey) for the period of 2000-2014 has been used for the longitudinal analysis. A comparison between two periods (the former period from 2000-2009 and the later period from 25 2010-2014) has been conducted using Logistic regression (including an interaction term of the period and treatment) model. The outcome variables considered for the three multiple logit analyses are the financial burden at 10%, 15% and 20%. They are defined as binary response variables with a value of one for those individuals whose ratio of out of pocket expenses to income is i) greater than or equal to 10% or ii) greater than or equal to 15% or iii) greater than or equal to 20% and 0 for others. These models evaluate the association between the type of health insurance (public and private) and financial burden of healthcare for the individuals, after controlling for socio- economic, geographic, demographic and living standard factors for the pre and post-declaration of the ACA period. Results: From the study, it can be observed that individuals with private insurance coverage have higher financial burden in comparison to individuals covered under public insurance. It is also evident that individuals with public insurance pre-ACA and private insurance both in pre-ACA and post ACA period are likely to have higher financial burden (at 10% (odd ratio=1.358, 95% C.I (1.238, 39 1.489), at 15% (odds ratio=1.353, 95% C.I (1.208, 1.514) and 20% (odds ratio=1.212, 95% C.I (1.068,1.374) when compared to public insurance users post-ACA period. Conclusion: The results suggest that with the declaration and implementation of ACA in 2010, individuals with public insurance coverage is less likely to have higher financial burden (ratio of out of pocket expenditures to income) in comparison to private insurance. Therefore, for the future period, the US government should focus on increasing access and coverage to public insurance for all individuals to control for financial burden from the grass root level and improve economic stability in US households.