Despite ACA, Out-of-Pocket Medical Costs Lurk

While the families had room in their budgets for necessities, health insurance premiums, and moderate levels of out-of-pocket costs, that was not the case with high levels of out-of-pocket costs. In each income range examined, some families would struggle to afford all their healthcare expenses because of high out-of-pocket costs.

For example, 10.8% to 17.5% of families with incomes between 100% and 200% of the FPL could not afford all their necessities plus health-related costs when they had high out-of-pocket medical costs. At 200% to 300% of FPL high out-of-pocket medical costs meant about a quarter of families could not afford all their necessities plus health-related costs. Families with incomes over 500% of FPL ($111,750 for a family of four) were found to have room in their budgets for healthcare even with high out-of-pocket costs.

"Our analysis is promising, as the vast majority of people will be better off because of the premium subsidies and cost-sharing limits in the Affordable Care Act," said Jonathan Gruber, an economics professor at MIT and the lead author of the report. "However, the concerns about high out-of-pocket costs are notable and should be addressed so that people who become very sick don't face out-of-pocket costs that they are unable to afford."

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