ACA Slowed Growth In Health Care Out-Of-Pocket Spending, JAMA Says

The Affordable Care Act has slowed increases in out-of-pocket costs for those with health insurance coverage under the law by about 80%, an analysis published Friday by JAMA Network Open found.

Since the ACA, also known as Obamacare, was enacted in 2010, average out-of-pocket expenses for doctor visits, prescription drugs and other services have risen by an average of 0.2% per year, the data showed.

However, during the nine years before the law's passage, from 2000 to 2009, these fees, which are charges over and above what insurance pays, increased by an average of 1% per year.

Much of this slowed growth in cash outlays for health services has been fueled by a 24% drop in out-of-pocket costs for prescription drugs under the health insurance law, according to the researchers.

"The rate of increase in out-of-pocket costs to consumers slowed as a result of the ACA," study co-author Dr. Amit Jain told UPI in an email.

Still, on average, people insured with ACA plans paid $1,148 in out-of-pocket costs in 2018, a 12% increase over the $1,028 spent in 2000, according to Jain and his colleagues.

"Unfortunately, not all states chose to [participate in the ACA], resulting in persistent inequities in access, which contribute to increasing out-of-pocket costs," said Jain, an orthopedic surgeon at Johns Hopkins Medicine in Baltimore.

Among other provisions, the ACA was designed to grow the number of people covered by either private health insurance plans or Medicaid by lowering costs for the former and expanding eligibility for the latter.

The Medicaid provision remains controversial over fears of rising costs for states as more beneficiaries access services under the government-funded program.

However, research has shown that Medicaid expansion under the ACA actually lowered healthcare expenditures for those covered.

For this study, Jain and his colleagues analyzed healthcare expenses on a per capita basis between 2000 and 2018 -- the nine years before and the nine years after the ACA's passage.

Out-of-pocket costs above what is covered by insurance or Medicaid -- for physician care increased by 0.5% per year between 2000 and 2009 and by 0.8% annually between 2009 and 2018, the data showed.

Conversely, for dental services, out-of-pocket expenses increased by 0.3% annually between 2009 and 2018, versus 1.7% per year between 2000 and 2009, the researchers said.

Out-of-pocket fees for prescription drugs declined by about 3% per year after passage of the ACA, after they had increased by more than 1% annually in the nine years before the law was enacted, according to the researchers.

"A mandate to expand insurance access to previously uninsured patients across all states would help improve care access and ultimately reduce net out-of-pocket expenditures," Jain said.

"Further, new laws that aim to limit out-of-network billing and surprise billing will further reduce out-of-pocket cost burden," he said.