Medicaid Expansion May Reduce Uninsured Hospital Patients
By Sara Heath
Despite being a major provision of the Affordable Care Act (ACA), Medicaid expansion has not been implemented in all states and is still having a notable effect on the states in which it has been adopted. According to a Kaiser Family Foundation study by Robin Rudowitz and Rachel Garfield, Medicaid expansion is decreasing the number of uninsured hospital patients.
The study examines hospital discharge data through the second quarter of 2014 in 16 states. Of the 16 states, 6 -- Florida, Georgia, Indiana, Missouri, Virginia, and Wisconsin -- had not yet adopted Medicaid expansion policies, and 10 — Arizona, California, Colorado, Hawaii, Iowa, Kentucky, Michigan, Minnesota, New Jersey, and New York — had adopted Medicaid expansion.
In 2014, hospitalizations in which Medicaid was the expected payer grew enormously, while hospitalizations for uninsured patients decreased. According to Rudowitz and Garfield, this is atypical. Normally, the authors said, these two factors grow and shrink together; when Medicaid hospitalizations increased, as did hospitalizations for the uninsured.
The study also did a comparison of Medicaid growth in expansion states compared to non-expansion states. In expansion states, hospital stays in which Medicaid was the payer increased by 16.3 percent. Hospital stays in which the patients were uninsured decreased by 36.9 percent. This shows that more patients who had recently been uninsured were now seeking coverage via Medicaid.
Non-expansion states saw a similar trend at a tremendously more modest rate. Hospital stays in which Medicaid was the payer increased by 0.5 percent, and those in which the patients were uninsured decreased by 2.9 percent. These data suggest that when a state expands Medicaid services to more individuals, the individuals enroll in Medicaid and there are thus fewer uninsured individuals.
Rudowitz and Garfield also broke down this information by medical condition, including asthma, coronary heart failure, diabetes, and surgical care. In expansion states, hospitalizations for Medicaid patients increased by as much as 34.5 percent, and hospitalizations for uninsured patients decreased by as much as 42.9 percent.
The study took a closer look at inpatient hospital stays for mental health episodes. Rudowitz and Garfield specifically examined this data because the results were “especially pronounced.” Between 2013 and 2014, inpatient hospital stays for uninsured patients in expansion states decreased by 44.4 percent, while in non-expansion states inpatient hospital stays increased by 5.8 percent. Inpatient hospital stays paid for by Medicaid increased by 36.5 percent in expansion states, but increased by only 4.6 percent in non-expansion states.
Rudowitz and Garfield project that in the future, results may not show the same disparities between expansion and non-expansion states. This is because adjustments to payer policies may be made in expansion states in response to the ACA. The authors also note that it will be important to keep an eye on how hospital financial situations persist as a result of Medicaid expansion. Rudowitz and Garfield state that as providers continue to experience this shift and collect data regarding Medicaid expansion, researchers will be able to reach a clearer idea of the effects of the ACA.
