Access and Affordability in Low- to Middle-Income Individuals Insured Through Health Insurance Exchange Plans: Analysis of Statewide Data

  • Uriel KimEmail author
  • Johnie Rose
  • Siran Koroukian


Individuals in states that expanded Medicaid eligibility under the Affordable Care Act are Medicaid-eligible if their income is < 138% of the federal poverty level (FPL). Above this threshold, those with incomes up to 400% FPL purchasing individual coverage on Health Insurance Exchanges (HIEs) may receive sliding-scale subsidies to offset premium costs. In addition, those with incomes up to 250% FPL who select benchmark “silver” HIE plans receive sliding-scale subsidies which offset out-of-pocket (OOP) expenses.1 We compared measures of access and affordability between Medicaid recipients in Ohio (an expansion state) and low/middle-income Ohioans whose incomes qualified them for HIE cost sharing subsidies.


We analyzed data from the 2015 Ohio Medicaid Assessment Survey, covering a representative sample of Medicaid and non-Medicaid Ohio adults ( n = 42,876). Data collection occurred approximately 1 year after the implementation of the state’s HIE and Medicaid...




Timothy Sahr

Director of Research and Analytics

Ohio College of Medicine Government Resource Center

Thomas E. Love

Professor of Medicine and of Population & Quantitative Health Sciences

Case Western Reserve University


No external funding was received for this study. Uriel Kim is supported by grants from the National Institutes of Health (GM007250, 1TL1TR002549), the Pharmaceutical Research and Manufacturers of America Foundation (PDHO18), the CWRU Center for Community Health Integration, and University Hospitals Cleveland Medical Center Department of Family Medicine and Community Health. Johnie Rose is supported by grants from the National Institutes of Health (UL1TR000439, 1UH2DE025487-01); the American Cancer Society (124673-MRSG-13-315-01-CPHPS); and the CWRU Center for Reducing Health Disparities. Siran Koroukian is supported by grants from the Ohio Medicaid Technical Assistance and Policy Program (MEDTAPP); the National Institutes of Health (P30 CA043703, R15 NR017792, and UH3-DE025487); the CDC (3 U48 DP005030-05S1, SIP 18-001); and contracts from Cleveland Clinic Foundation, including a subcontract from Celgene Corporation. The funders had no role in the study design; collection, analysis, and interpretation of data; writing the manuscript; and the decision to submit the manuscript for publication.

Compliance with Ethical Standards

Conflict of Interest

Uriel Kim has no conflicts of interest to disclose. Johnie Rose is the co-founder and Chief Medical Officer of VINYA Intelligence, Inc., a healthcare artificial intelligence firm developing remote patient monitoring solutions. None of the firm’s work relates directly to the content of the manuscript. Siran Koroukian has no conflicts of interest to disclose.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Center for Community Health Integration Case Western Reserve University School of MedicineClevelandUSA
  2. 2.Department of Population and Quantitative Health SciencesCase Western Reserve University School of MedicineClevelandUSA

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