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Out of Pocket Caps State Reports

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Topics: Health Care Reform | Legislation (National) | Out-of-Pocket | Spending

Families USA is releasing state-specific reports on the impact of the national health care reform law’s out-of-pocket (OOP) spending cap.  Beginning in 2014, health reform institutes a cap on OOP spending for certain covered services on an income-based sliding scale.  To estimate the number of people affected by the cap, the briefs project how many individuals in each state will exceed the OOP cap in 2011 

From the summary:

To relieve consumers of some of this financial burden, the Patient Protection and Affordable Care Act (Affordable Care Act) places caps on how much money insured people will have to spend out of their own pockets for health care services that are covered in the new law’s essential benefits package. These caps on out-of-pocket health care spending will go into effect in 2014, when millions of Americans begin to purchase coverage in the new health insurance exchanges. The out-of-pocket spending caps will follow a sliding scale: Those with lower and middle incomes will pay less out of pocket than those with higher incomes. The new caps guarantee that consumers will not have to pay more than a set amount annually in out-of-pocket expenses for these covered services.

Families USA commissioned The Lewin Group to analyze health care spending and determine how many people in each state are in families that will have out-of-pocket spending that exceeds these new caps, and by how much. We asked The Lewin Group to base their estimates on expected patterns of health care spending for 2011.

Full Reports: Out of Pocket Caps State Reportsexit disclaimer small icon 

Families USA. (2011). Out of pocket caps state report.


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