Preexisting Condition Protections Under the Affordable Care Act: Changes in Insurance Coverage,Premium Contributions,and Out-of-Pocket Spending |
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| Institution: | 1. Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA;2. Geisel School of Medicine at Dartmouth, Hanover, NH, USA;3. Section of Allergy and Immunology, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO, USA;1. Health Economics Unit, Centre for Health Policy, Melbourne School of Global and Population Health, University of Melbourne, Melbourne, Victoria, Australia;2. Murdoch Children’s Research Institute, Melbourne, Victoria, Australia;3. Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia;4. Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia;5. Department of Allergy and Immunology, The Royal Children’s Hospital, Melbourne, Victoria, Australia;1. Peter J. O''Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA;2. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA;3. Department of Economics, Statistics, and Sociology, RAND Corporation, Arlington, VA, USA;4. Department of Otolaryngology—Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA;1. Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands;2. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA;3. Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale University School of Medicine, New Haven, CT, USA;4. Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA;5. Netherlands Institute for Health Sciences, Erasmus University Medical Center, Rotterdam, The Netherlands;6. Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA;1. School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China;2. Center for Social Science Survey and Data, Tianjin University, Tianjin, China;3. Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China;4. Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;5. Tianjin’s Clinical Research Center for Cancer, Tianjin, China;6. Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China;7. Department of Clinical Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China;8. Department of Health Research Methods, Evidence and Impact and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada |
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| Abstract: | ObjectivesIn January 2014, the Affordable Care Act (ACA) preexisting condition protections prohibited coverage denials, premium increases, and claim denials on the basis of preexisting conditions. This study aimed to examine changes in coverage and premiums and out-of-pocket spending after the implementation of the preexisting condition protections under the ACA.MethodsWe identified adults aged 18 to 64 years with (n = 59 041) and without preexisting conditions (n = 61 970) from the 2011-2013 and 2015-2017 Medical Expenditure Panel Survey. We used a difference-in-differences and a difference-in-difference-in-differences approach to assess the associations of preexisting condition protections and changes in insurance coverage, premium contributions, and out-of-pocket spending after the ACA. Simple and multivariable logistic or multivariable 2-part models were fitted for the full sample and stratified by family income (low ≤138% federal poverty level FPL]; middle 139%-400% FPL; and high > 400 FPL).ResultsThe ACA increased nongroup insurance coverage to a similar extent for individuals with or without preexisting conditions at all income levels. Decreases in premium contributions were observed to a similar extent among families with nongroup private coverage regardless of declinable preexisting condition status, whereas no significant changes were observed among families with group coverage. We found greater decreases in out-of-pocket spending for individuals with preexisting conditions than those without conditions among both individuals covered by nongroup and group insurance, and a greater difference was observed among those covered by nongroup insurance (difference-in-difference-in-differences ?$279; 95% confidence interval ?$528 to ?$29).ConclusionsThe ACA protections were associated with decreases in out-of-pocket spending among adults with preexisting conditions. |
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| Keywords: | health conditions health insurance health insurance premium preexisting condition protections the Affordable Care Act |
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