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We examined the effect of the expansion of Medicaid eligibility under the Affordable Care Act on health insurance coverage and labor supply of low-educated and low-income adults. We found that the Medicaid expansions were associated with large increases in Medicaid coverage, for example, 50 percent among childless adults, and corresponding decreases in the proportion uninsured. There was relatively little change in private insurance coverage, although the expansions tended to decrease such coverage slightly. In terms of labor supply, estimates indicated that the Medicaid expansions had little effect on work effort despite the substantial changes in health insurance coverage. Most estimates suggested that the expansions increased work effort, although not significantly.

In Lao People's Democratic Republic (PDR), community-based health insurance (CBHI) is the only voluntary insurance scheme; it typically targets self-employed people, most of whom reside in rural areas and are dependent on agricultural activities for subsistence. However, until very recently, the enrollment rate has fallen short and failed to reach a large percentage of the target group. To promote the CBHI scheme and increase demand, some supporting components should be considered for inclusion together with the health infrastructure component. This paper provides empirical evidence that the benefit package components of hypothetical CBHI schemes have causal effects on enrollment probabilities. Furthermore, we examine the distribution of willingness to pay (WTP) in response to policy changes based on a sample of 5,800 observations. A randomized conjoint experiment is conducted in rural villages in Savannakhet Province, Lao PDR, to elicit stated preference data. Each respondent ranks three options-two hypothetical alternatives and the CBHI status quo scheme. The levels of seven attributes-insurance coverage for medical consultations, hospitalizations, traffic accidents, pharmaceuticals and transportation; premiums; and prepaid discounts-are randomly and simultaneously assigned to the two alternatives. The findings suggest that the average WTP is at least as large as 10.9% of the per capita income of those who live in rural areas, which is higher than the WTP for health insurance averaged across low- and middle-income countries (LMICs) in the literature. The component of round-trip transportation insurance coverage has a significant effect on WTP distribution, particularly increasing the share of the highest bin. Therefore, the low CBHI scheme enrollment rate in Lao PDR does not necessarily imply low demand among the targeted population, as the finding from the WTP analysis illustrates potential demand for the CBHI scheme. Specifically, if transportation is addressed, enrollment is likely to significantly increase.

Although financial toxicity is widely acknowledged to be a potential consequence of costly cancer treatment, little is known about its prevalence and outcome among the Indian population. In this study, we systematically reviewed the prevalence, determinants, and consequences of financial toxicity among patients with cancer in India. 22 studies were included in the systematic review. The determinants of financial toxicity include household income, type of health-care facility used, stage of disease, area of residence, age at the time of diagnosis, recurrent cancer, educational status, insurance coverage, and treatment modality. Financial toxicity was associated with poor quality of life, accumulation of debts, premature entry into the labour market, and non-compliance with therapy. Our findings emphasise the need for urgent strategies to mitigate financial toxicity among patients with cancer in India, especially in the most deprived sections of society. The qualitative evidence synthesised in this systematic review could provide a basis for the development of such interventions to reduce financial toxicity among patients with cancer.

US health care spending increased 5.3 percent to $3.0 trillion in 2014. On a per capita basis, health spending was $9,523 in 2014, an increase of 4.5 percent from 2013. The share of gross domestic product devoted to health care spending was 17.5 percent, up from 17.3 percent in 2013. The faster growth in 2014 that followed five consecutive years of historically low growth was primarily due to the major coverage expansions under the Affordable Care Act, particularly for Medicaid and private health insurance, which contributed to an increase in the insured share of the population. Additionally, the introduction of new hepatitis C drugs contributed to rapid growth in retail prescription drug expenditures, which increased by 12.2 percent in 2014. Spending by the federal government grew at a faster rate in 2014 than spending by other sponsors of health care, leading to a 2-percentage-point increase in its share of total health care spending between 2013 and 2014.

By September 2015, a total of 29 states and Washington, D.C., were participating in the ACA Medicaid expansion. During year 2 after implementation, the expansion was associated with substantial reductions in rates of uninsurance and in reports of inability to afford health care. The Affordable Care Act (ACA) expanded Medicaid eligibility to persons earning up to 138% of the federal poverty level, as part of the largest expansion of coverage to nonelderly adults since the 1960s. Although the expansion was originally intended to be enacted nationally, a 2012 U.S. Supreme Court decision made it optional for states. A total of 24 states decided not to expand in 2014, which affected 6.7 million uninsured low-income adults who otherwise would have gained eligibility. 1 Since 2014, an additional 5 states have implemented expansions, although 19 states still have not adopted the expansion as of January 2017. . . .

AbstractObjectiveTo estimate changes in healthcare spending in the US after implementation of the No Surprises Act (NSA) in 2022 among adults with direct purchase private insurance.DesignQuasi-experimental difference-in-differences study.Setting24 US states.ParticipantsAdults aged 19-64 years with direct purchase private insurance who participated in the Annual Social and Economic Supplement of the Current Population Survey 2019-24 and resided in states that gained NSA surprise billing protections (intervention states) or in states with comprehensive protections already in place (control states).Main outcome measuresInflation adjusted out-of-pocket spending, insurance premium spending, and high burden medical spending (defined as spending >10% of total family income on both out-of-pocket and premium costs).ResultsThe study population included 17 351 privately insured adults, with 8204 residing in the 18 intervention states and 9147 in the six control states. After implementation of the NSA, out-of-pocket spending showed a decline among privately insured adults in intervention states (from $3674 (£2776; €3214) to $2922, relative percentage change −16.5%, 95% confidence interval (CI) −27.9% to −3.2%), but not among privately insured adults in control states ($2704 to $2550, 1.9%, −11.6% to 17.4%). A significant differential reduction was observed in out-of-pocket spending among privately insured adults in intervention states compared with control states after the NSA (relative percentage change −18.0%, −30.2% to −3.7%; absolute change −$567, 95% CI −$1031 to −$102; P=0.02). In contrast, no differential changes were observed in premium spending (relative percentage change 1.9%, −13.9% to 20.7%; absolute change $93, −$737 to $924; P=0.82) and in high burden medical spending (absolute percentage point change −1.0%, 95% CI −5.2% to 3.1%, P=0.62) between the two groups. These findings were consistent across sociodemographic characteristics, including sex, race/ethnicity, poverty status, education level, and employment status.ConclusionsSubstantial declines occurred in out-of-pocket spending among direct purchase privately insured adults who gained NSA surprise billing protections. In contrast, premium spending and high burden medical spending did not change. Additional policy efforts are needed to reduce healthcare related financial strain in the US.

Expanding eligibility for Medicaid was a central goal of the Affordable Care Act (ACA), which continues to be debated and discussed at the state and federal levels as further reforms are considered. In an effort to provide a synthesis of the available research, we systematically reviewed the peer-reviewed scientific literature on the effects of Medicaid expansion on the original goals of the ACA. After analyzing seventy-seven published studies, we found that expansion was associated with increases in coverage, service use, quality of care, and Medicaid spending. Furthermore, very few studies reported that Medicaid expansion was associated with negative consequences, such as increased wait times for appointments-and those studies tended to use study designs not suited for determining cause and effect. Thus, there is evidence to document improvements in several areas of health care delivery following the ACA Medicaid expansion. We outline areas for future research that can further reduce current knowledge gaps.

There has been broad variation among states in policy approaches to unwinding of continuous Medicaid coverage. But there is still time for policymakers and others to minimize the risk of coverage loss.

Inequalities in medical care are endemic in the USA. The Affordable Care Act (ACA), passed in 2010 and fully implemented in 2014, was intended to expand coverage and bring about a new era of health-care access. In this review, we evaluate the legislation's impact on health-care equity. We consider the law's coverage expansion, insurance market reforms, cost and affordability provisions, and delivery-system reforms. Although the ACA improved coverage and access—particularly for poorer Americans, women, and minorities—its overall impact was modest in comparison with the gaps present before the law's implementation. Today, 29 million people in the USA remain uninsured, and substantial inequalities in access along economic, gender, and racial lines persist. Although most Americans agree that further reform is needed, the proper direction for reform—especially following the 2016 presidential election—is highly contentious. We discuss proposals for change from opposite sides of the political spectrum, together with their potential impact on health equity.

BackgroundBariatric surgery remains underutilized at a national scale, and insurance company reimbursement is an important determinant of access to these procedures. We examined the current state of coverage criteria for bariatric surgery set by private insurance companies.MethodsWe surveyed medical policies of the 64 highest market share health insurance providers in the USA. ASMBS guidelines and the CMS criteria for pre-bariatric evaluation were used to collect private insurer coverage criteria, which included procedures covered, age, BMI, co-morbidities, medical weight management program (MWM), psychosocial evaluation, and a center of excellence designation. We derive a comprehensive checklist for pre-bariatric patient evaluation.ResultsSixty-one companies (95%) had defined pre-authorization policies. All policies covered the RYGB, and 57 (93%) covered the LAGB or the SG. Procedures had coverage limited to center of excellence in 43% of policies (n = 26). A total of 92% required a BMI of 40 or above or of 35 or above with a co-morbidity; however, 43% (n = 23) of policies covering adolescents (n = 36) had a higher BMI requirement of 40 or above with a co-morbidity. Additional evaluation was required in the majority of policies (MWM 87%, psychosocial evaluation 75%). Revision procedures were covered in 79% (n = 48) of policies. Reimbursement of a second bariatric procedure for failure of weight loss was less frequently found (n = 41, 67%).ConclusionsA majority of private insurers still require a supervised medical weight management program prior to approval, and most will not cover adolescent bariatric surgery unless certain criteria, which are not supported by current evidence, are met.