The Affordable Care Act (ACA) improved welfare by expanding, subsidizing, and standardizing healthcare coverage. At the same time, the law also penalizes the remaining uninsured and establishes a benchmark private policy that charges premiums and cost-sharing expenses in the non-group market. This paper introduces a conceptual and empirical framework for evaluating the net effects of ACA coverage expansions for the individual welfare of previously uninsured adults. Using restricted-access data from the 2010–2012 Medical Expenditure Panel Survey, I evaluate the short-term welfare effect as a function of health and non-medical consumption. I simulate post-ACA insurance status then evaluate the change in expected medical consumption and the utility of consumption by estimating parameter values for a generalized gamma distribution of the ex-ante spread of healthcare and medical spending for each person. The ACA generates a modest net improvement in individual welfare on average (+ $91). While low-income individuals realize gains (+ $539), all other income-groups realize increasingly large losses. The uninsured majority (65%) realize average losses (− $158). Medicaid beneficiaries realize substantial gains (+ $1309). While in most specifications, exchange enrollees realize average gains (+ $146), just under a quarter (24%) realizes any improvement. The chronically-ill realize substantial gains (+ $1065). The non-chronically-ill majority (71%) realize average losses (− $312). Despite weakly lower risk premiums (− $28), medical spending increases in catastrophic scenarios on average. The ACA improves the welfare of some, especially the low-income and chronically-ill. Medicaid generates unequivocal gains for beneficiaries. Most previously uninsured adults remain uninsured, some of whom pay a penalty. The subsidized cost of ACA private insurance outweighs its benefits for most exchange enrollees.

中文翻译：

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《经济适用医疗法》对以前没有保险的成年人的个人福利影响。

《平价医疗法案》（ACA）通过扩大，补贴和标准化医疗保健覆盖范围来改善福利。同时，法律还对剩余的未投保者进行处罚，并建立了基准私人保单，该保单对非集团市场收取保费和费用分摊费用。本文介绍了一个概念和经验框架，用于评估ACA覆盖范围扩大对以前没有保险的成年人的个人福利的净影响。我使用2010-2012年医疗支出小组调查的限制访问数据，评估了短期福利效应与健康和非医疗消费的关系。我模拟了ACA保险后的状况，然后通过估计每个人医疗和医疗支出事前分布的广义伽玛分布的参数值来评估预期医疗消费量的变化和消费效用。平均而言，ACA在个人福利方面产生了适度的净增长（+ $ 91）。低收入者实现了收益（+ 539美元），而所有其他收入群体都实现了越来越大的损失。未投保的大多数人（65％）实现平均损失（− $ 158）。医疗补助受益人实现了可观的收益（+ $ 1309）。虽然在大多数规范中，交换生都实现了平均收益（+ 146美元），但是不到四分之一（占24％）的收益得到了改善。长期患病的人实现了可观的收益（+ $ 1065）。非慢性病患者中的大多数（71％）实现平均损失（-$ 312）。尽管风险保费较低（-$ 28），但在灾难性情况下医疗支出平均会增加。ACA改善了某些人的福利，尤其是低收入和长期病患者。医疗补助为受益人带来了明确的收益。大多数以前没有保险的成年人仍然没有保险，其中一些人要缴纳罚款。对于大多数交换生而言，ACA私人保险的补贴成本超过其收益。