Medicaid Expansion May Have Led More Medicaid Patients Seeking Care at Non–Safety-Net Hospitals

Following implementation of the Affordable Care Act (ACA), Medicaid-funded hospital stays rose overall, but the trend was more pronounced for hospitals not designated as “safety net” hospitals, a new AHRQ study indicates. The results suggest that newly enrolled Medicaid patients, when given the option, may be choosing non–safety-net hospitals rather than safety-net hospitals for their care, researchers said. The study, published in Health Services Research, found that Medicaid-funded hospital stays increased about 14 percent more in non–safety-net hospitals than their safety-net counterparts between 2013 and 2014, when Medicaid was expanded under the ACA. Safety-net hospitals are those that care for a larger-than-usual proportion of patients who are low income, uninsured or underinsured. These hospitals typically receive additional reimbursements through federal, state, and local funding mechanisms. The study was based on data from AHRQ’s Healthcare Cost and Utilization Project. Access the abstract.

2018 Jan 21. doi: 10.1111/1475-6773.12812. [Epub ahead of print]

Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares.

Wu VY1, Fingar KR2,3, Jiang HJ4, Washington R5, Mulcahy AW6, Cutler E7, Pickens G3.

Author information

Abstract

OBJECTIVE:

To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs).

STUDY SETTING:

Nine Medicaid expansion states.

STUDY DESIGN:

Differences-in-differences (DID) models compare payer-specific pre-post changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs.

DATA COLLECTION METHODS:

2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases.

PRINCIPAL FINDINGS:

On average per quarter postexpansion, SNHs and non-SNHs experienced similar relative decreases in uninsured stays (DID = -2.2 percent, p = .916). Non-SNHs 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 non-SNHs, the decrease in uninsured (-63) plus privately insured (-33) stays was similar to the increase in Medicaid stays (105). SNHs and non-SNHs experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined (DID = -16, p = .162).

CONCLUSIONS:

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