Catastrophic expenditures in California trauma patients after the Affordable Care Act: reduced financial risk and racial disparities

Hospital charges due to major injury can result in high out-of-pocket expenses for patients. We analyzed the effect of the Affordable Care Act (ACA) on catastrophic health expenditures (CHE) among trauma patients. We identified trauma patients aged 19-64 admitted to a safety-net Level 1 trauma center in California from 2007 to 2017. Out-of-pocket expenditures and income were calculated using hospital charges, insurance status, and ZIP code. CHE was defined using the World Health Organization definition of out-of-pocket spending exceeding 40% of inflation-adjusted income minus food and housing expenditures. Multivariable logistic regression was performed to assess odds of CHE post-ACA (2014–2017) vs. pre-ACA (2007–2013). Of 7519 trauma patients, 20.6% experienced CHE, including 89.0% of uninsured patients. There was a 74% decrease in odds of CHE post-ACA (aOR: 0.26, 95% CI: 0.22–0.30), with greater decreases among Black (aOR: 0.09, 95% CI: 0.04–0.18) and Hispanic (aOR: 0.23, 95% CI: 0.19–0.29) patients. ACA implementation was associated with markedly decreased odds of catastrophic expenditures and decreased racial disparities in financial protection among trauma patients in our study. •The Affordable Care Act (ACA) expanded insurance coverage in the United States.•ACA was associated with 74% lower risk of catastrophic spending by trauma patients.•White-Black and White-Hispanic disparities in catastrophic spending also decreased.•One in 11 trauma patients continues to experience catastrophic spending post-reform.