What is the fine-grained topic of the following text: Results: Average out-of-pocket spending decreased overall, largely because of reductions in spending among people eligible for the Medicaid expansion and cost-sharing and premium subsidies on the insurance exchanges; premium spending went up mostly because of large increases for those with higher incomes; combined out-of-pocket plus premium spending decreased only for those in the lowest-income group. Only return the topic.
Changes in Out-of-Pocket and Premium Spending in Healthcare