An Examination of Household Health Spending and Medical-Financial Experience Circa Enactment of the Affordable Care Act of 2010



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This dissertation uses an expansive definition of medical-financial experience (MFE) to describe the benefits health insurance, at the outset of the Affordable Care Act (ACA). Publicly-insured families generally had greater access to medical care, with lower burden and risk of catastrophic spending than uninsured families. Privately-insured families had greater access to care and better predictability of overall costs than uninsured families, but these benefits were achieved along with greater overall burden and exposure to extreme spending. Many risk-averse families with low- and middle-income attracted to the benefits of insurance were still poised to face untenable tradeoffs even after the first wave of ACA reforms. This dissertation argues for an increased focus on specific policy remedies that better align spending exposure to income for all families and that recognize the additional capabilities needed to manage the stochastic, multidimensional character of MFE.