Annual out-of-pocket medical expenses fell by an average 11.9% for adults under age 65 during 2014 and 2015, while the average annual premium increased 12.1%, according to a study reported today in JAMA Internal Medicine. The study looked at changes in out-of-pocket spending and premiums after the Affordable Care Act’s main coverage provisions took effect in 2014, and found average out-of-pocket spending and premiums declined for all individuals and households except those earning more than 400% of the federal poverty level. “Repealing or otherwise dismantling the legislation without a suitable replacement could cause financial harm to many lower-income families,” the authors said. “…Reforms to the ACA that could improve household spending burdens include expanding Medicaid in all states, increasing the generosity of cost-sharing and premium subsidies, and increasing the actuarial values of standard exchange plans.”