Did Marketplace coverage really offer financial protection? Financial gains from the Affordable Care Act's private insurance policies among the previously uninsured

While the Affordable Care Act successfully expanded health insurance access, the law's private insurance component drew far fewer participants than projected. This study investigates the attractiveness of Marketplace insurance relative to uncompensated care provisions for those who remain uninsured. Using restricted-access Medical Expenditure Panel Survey data, I find that for one in four previously uninsured consumers, bankruptcy costs less than meeting the deductible of the subsidized benchmark policy. Marketplace insurance reduces spending in only the top 3% most catastrophic potential scenarios these consumers face, on average. Net financial gain is more common among individuals in poor health (11% vs. 1%) or with assets to protect (3% vs. <1%). High-deductible insurance aims to protect wealth in catastrophic scenarios. However, hospitals substantially discount care for the uninsured in such scenarios. High-deductible coverage might not be an effective driver of financial security for the uninsured, which may help to explain low Marketplace enrollment.