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Health Insurance and Bankruptcy Risk: Examining the Impact of the Affordable Care Act

As is well-known, the Affordable Care Act (“ACA”) is an incredibly hot political issue across the country. The ACA was originally proposed in large measure due to the destruction that outstanding medical bills can have on family finances. Most of the existing legal scholarship on medical debt and bankruptcy over the past forty years has tried to answer the question of what percentage of bankruptcy filings are “medical bankruptcies.” To date, this effort has proven inconclusive. 
 
In this Essay, we ask a much more timely and substantive question, namely, what is the relationship between possessing health insurance and the risk of filing for bankruptcy and how does this vary in pre- and post-ACA time periods? Given the expressed intent behind the ACA to reduce the number of individuals filing for bankruptcy relief as a consequence of inadequate or non-existent health insurance, studies like ours, which looks specifically at the correlation between health insurance and bankruptcy filings, are essential to understanding the impact of the ACA at a time when it remains under constant legal challenge. 
 
Our study adds to, and advances, the existing literature by finding that the ACA has had an important role on the relationship between intermittent health care coverage and the risk of filing for bankruptcy protection. Stated differently, our findings suggest that by more robustly providing health insurance coverage for low-income Americans, the ACA has had some effect on the risk of filing for bankruptcy protection. Our preliminary findings suggest that the ACA may lower one’s risk for bankruptcy, particularly for those in the lowest income group in the country. This is a significant finding in assisting to answer the question of whether the ACA is working as a matter of federal law. Moreover, the study will be of interest to academics and policymakers across multiple discipline areas, including health care policy, bankruptcy law, insurance law, poverty and inequality, sociology, and politics.