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Despite ACA, Out-of-Pocket Medical Costs Lurk

Margaret Dick Tocknell, for HealthLeaders Media, April 27, 2011

Ninety percent of American families living above the federal poverty level ($22,350 for a family of four) will be able to afford health insurance thanks to the Affordable Care Act, according to a Commonwealth Fund report released Wednesday. But families with high out-of-pocket medical costs may continue to struggle.

The report, "Will The Affordable Care Act Make Health Insurance Affordable?" finds that new subsidies available through health insurance exchanges established under the ACA will make premiums affordable for most families.

The exchanges, which are scheduled to begin in 2014, will offer a federally determined essential benefits package. Health plans in the exchanges must cover, on average, 60% of the costs of the insurance. In addition, the out-of-pocket limit for enrollee spending can't exceed the regulated level for health savings accounts or about $6,000.

The Commonwealth Fund report uses consumer spending data to analyze family budgets across income levels, and compares them to the costs of purchasing health insurance through HIEs and typical out-of-pocket healthcare spending. The analysis shows that the majority of families, even lower-income families, have room in their budgets for premiums and typical out-of-pocket costs.

Households between 100% and 150% of the FPL (up to $33,525 for a family of four) spend 75 percent of their resources on necessities—including child care, food, housing, taxes and transportation—leaving most families in that income range able to afford some health-related expenses.

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