prior to full implementation of the ACA, and the dashed black line is some time after full implementation. As healthy previously uninsured people (i.e., those without much out-of-pocket spending for health care) in households slightly above the poverty line have their incomes reduced to less than the SPM by premiums post-ACA, the dashed curved line is initially above the black solid curved line. However, the lines soon cross, as less healthy people who are newly insured experience out-of-pocket premiums plus spending for care that is less than their prior out-of-pocket spending, and thus their household incomes are not reduced below the SPM threshold.

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