Affordable Care Act (ACA) implementation was associated with 2 million fewer adults with catastrophic expenditures each year, researchers write in JAMA Open Network. Catastrophic medical expenditures are defined as those that force people to spend more than 40% of their income on health costs (out-of-pocket plus premium) after accounting for subsistence items (e.g., food and housing). Nevertheless, each year, 11 million U.S. adults, including 6 million with private insurance, experience catastrophic health expenditures. The numbers are likely to grow during the pandemic, according to the researchers. “Health reform should move beyond expanding insurance coverage alone to address persistently high out-of-pocket spending among the insured.”