This paper examines the incidence of the cost burden associated with expanding public health insurance to low-income adults in the context of the Affordable Care Act. Using data from the Medical Expenditures Panel Survey (MEPS), I exploit exogenous variation in Medicaid eligibility rules across states, income groups and time. I find that public insurance eligibility reduced mean out-of-pocket spending by 19.6 percent among targeted households, but it did not causally increase total expenditures among beneficiaries. Rather, Medicaid expansion shifted the burden of payment from eligible households and private insurance (21.5 percent reduction) to taxpayers in the form of public insurance (46.6 percent increase). The efficiency of these public funds can be summarized by a mean Marginal Value of Public Funds of 0.70 in the full sample, 0.99 among households with at least one pre-existing condition, and 1.26 in states with an above-median number of public hospitals.

中文翻译：

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公共健康保险和医疗支出：ACA 医疗补助扩张的发生率

本文研究了在《平价医疗法案》的背景下将公共健康保险扩大到低收入成年人相关的成本负担的发生率。使用来自医疗支出面板调查 (MEPS) 的数据，我利用了跨州、收入群体和时间的医疗补助资格规则的外生变化。我发现，公共保险资格使目标家庭的平均自付费用减少了 19.6%，但并没有因果增加受益人的总支出。相反，扩大医疗补助计划将支付负担从符合条件的家庭和私人保险（减少 21.5%）转移到公共保险形式的纳税人（增加 46.6%）。这些公共资金的效率可以通过全样本 0.70 的平均公共资金边际价值来概括。