ACA & Medicaid Cost-Sharing

The New England Journal of Medicine (NEJM) has published an article on March 27, 2014, on Pinching the Poor? Medicaid Cost Sharing under the ACA.   The article, as the title implies, examines cost-sharing, describing it as “a growing trend in Medicaid — one that raises important questions about balancing state budgetary concerns and appropriate incentives with adequate protections for patients.”  The article examines the objectives of cost-sharing: personal responsibility, and  lower spending with greater efficiency.  The article discusses the potential burden cost-sharing may have on beneficiaries as well as the negative outcomes that can occur from requiring cost-sharing. The article concludes that there needs to be sufficient oversight and evaluation to determine the effectiveness of imposing cost-sharing on beneficiaries:

Cost sharing is a complicated policy tool. Policymakers have a responsibility to monitor new programs to understand their impact on costs, quality, access, and health and to use the knowledge that is gained to more effectively support the ability of Medicaid enrollees to make good decisions regarding health care. Ultimately, if this sort of flexibility encourages more states to expand Medicaid, most low-income adults will be better off for the effort — since some cost sharing is almost certainly preferable to being left without any coverage at all.