Though the Affordable Care Act has greatly expanded access to health insurance, ACA marketplace customers still spend a considerable share of their incomes on healthcare expenses, according to a new analysis from the Robert Wood Johnson Foundation and the Urban Institute.
The analysis assessed the healthcare financial burdens facing the modest-income population enrolling in marketplace coverage using federal financial assistance as well as the financial burden of higher-income individuals and families who are purchasing qualified health plans in the non-group market with their own funds.
People at the lower end of the federal poverty level (FPL) had to spend more, percentage-wise, of their income to purchase the same coverage than individuals at the higher end of that income range. With those who make 300 percent of the FPL, about 13 percent of their income goes toward premiums, whereas people who make 400 to 500 percent of the FPL spend about 15.6 percent of their income on premiums.
The Urban Institute pointed out that the ACA could improve the affordability of marketplace coverage by linking tax credits to gold plans, rather than silver plans, in order to reduce deductibles and out-of-pocket payments from current levels for tax credit eligible individuals. The analysis also pointed out that the risk of not making coverage more affordable is that more individuals may choose not to purchase coverage, pay the tax penalty instead, and hinder the ACA's ability to achieve and maintain its coverage objectives.
Recent research shows that high deductibles are a major reason many Americans go without coverage. Still, the share of all nonelderly adults who reported forgoing care due to cost in the past year dropped has from 35 percent to 32.3 percent.
To learn more:
- here is the Urban Institute analysis