Powered by: Blackwell Publishing

HRET - Health Research & Educational Trust

HSR - Health Services Research

Impacting Health Practice and Policy Through State-of-the-Art Research and Thinking

Our Next Issue

December 2018
Coming Soon! Read

< ABSTRACT LIST

VOLUME 53 | NUMBER 5 | OCTOBER 2018


Early Impact of the Affordable Care Act Coverage Expansion on SafetyNet Hospital Inpatient Payer Mix and Market Shares

Objective: To examine the impact of the Affordable Care Act's coverage expansion on safetynet hospitals (SNHs).

Study Setting: Nine Medicaid expansion states.

Study Design: Differencesindifferences (DID) models compare payerspecific prepost changes in inpatient stays of adults aged 19–64 years at SNHs and nonSNHs.

Data Collection Methods: 2013–2014 Healthcare Cost and Utilization Project State Inpatient Databases.

Principal Findings: On average per quarter postexpansion, SNHs and nonSNHs experienced similar relative decreases in uninsured stays (DID = –2.2 percent, p = .916). NonSNHs experienced a greater percentage increase in Medicaid stays than did SNHs (DID = 13.8 percent, p = .041). For SNHs, the average decrease in uninsured stays (–146) was similar to the increase in Medicaid stays (153); privately insured stays were stable. For nonSNHs, the decrease in uninsured (–63) plus privately insured (–33) stays was similar to the increase in Medicaid stays (105). SNHs and nonSNHs experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined (DID = –16, p = .162).

Conclusions: Postexpansion, nonSNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing nonSNHs over SNHs or a crowdout of private insurance. More research is needed to understand these trends.

back to top | back to article index | access/purchase full article

Copyright© 2018, Health Research & Educational Trust. All rights reserved. Content Disclaimer
Health Research & Educational Trust, 155 North Wacker, 4th Floor Chicago, IL 60606 (312) 422.2600