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.
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