New Case: Losses (and Gains) from Health Reform for Non-Medicaid Uninsureds

This article examines how the Affordable Care Act (ACA) would change financial resources for and transfers to the previously uninsured if they were to purchase coverage in the ACA insurance exchanges (marketplaces) in 2014. The results suggest that the law provides gains to some, relative to their spending in the pre-ACA period, particularly those in poor health and with very low incomes, but it also potentially imposes financial losses on many, again compared to their experience when uninsured. We estimate changes in expected payments—defined as premiums plus expected out-of-pocket costs—from purchasing coverage and paying cost sharing post-ACA, relative to expected out-of-pocket payments when being uninsured pre-ACA, across population subgroups characterized by income, age, and health status. We also estimate changes in expected transfers to the previously uninsured under alternative assumptions on how much health care spending increases after the ACA.