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ACA helps trauma patients avoid financial catastrophe, but more is needed

The Affordable Care Act has reduced the number of people who face overwhelming hospital bills after trauma, but many are still vulnerable.

The 2010 Affordable Care Act has provided a financial safety net for many who land in the hospital after trauma, such as an accident, car crash or gunshot wound, Stanford researchers have found. Yet other patients who lack insurance or whose coverage is inadequate still face overwhelming bills.

"The decrease in the number of injured patients who experience a catastrophic health expenditure was quite sizable," said Charles Liu, MD, a resident in surgery.

Liu is the lead author of an article about the study published in JAMA Network Open.

The researchers found that after the ACA was enacted, trauma patients were 31% less likely to have hospital bills and premiums that were as much as, or more than, one-fifth their family's annual income. Patients in the lowest-income bracket -- those who earn 138% or less of the federal poverty level (about $17,000 for an individual or $34,000 for a family of four) -- were 39% less likely to be faced with such catastrophic costs.

Liu said that much of the protection from overwhelming bills was due to the greater number of people who qualify for Medicaid -- the government insurance program generally for lower-income people -- under the ACA. He added, however, "Even though we've taken a big step, the problem has not been solved."

The research showed that even after the ACA was enacted, one in 11 of all trauma patients, and one-fifth of those in the lowest-income bracket, faced bills and premiums that exceeded 20% of their family's annual income.

The financial protections the ACA provides don't help everyone. Fourteen states have not expanded their Medicaid eligibility, as the ACA allows, and other states have failed to promote their Medicaid programs, so residents are often unaware that they are eligible. In addition, people who earn too much to qualify for Medicaid may receive help from the ACA's subsidies to buy private insurance, but coverage is often insufficient.

"There are fewer and fewer people who are uninsured, but there's a growing number of people who are underinsured," Liu said, referring to those whose health plans require high out-of-pocket costs.

"It's not just about getting everyone covered, but also making sure that insurance is protective," he added. "There's more work to be done to protect Americans from financial catastrophe because of health care bills."

Photo by Camilo Jimenez

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