Association for Public Policy Analysis & Management

The purpose of the Affordable Care Act (ACA) was to reduce the rate of uninsured Americans, providing increased access to health care and reducing the burden of out-of-pocket (OOP) health care related spending. Little is known about the effects of these uneven insurance gains on pre-existing OOP spending disparities by race or ethnicity. This paper takes a difference-in-differences approach to estimating the effects of Medicaid expansion on disparities in OOP spending among low-income households. Preliminary evidence shows Medicaid expansion reduced OOP spending related to private health insurance, reducing the share or households reporting high burdens of OOP spending. We see the largest reductions in OOP spending among White respondents, with Black respondents reporting the second largest gains. Hispanic households experienced the smallest financial relief at the individual and household level.