Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;53(5):3617-3639.
doi: 10.1111/1475-6773.12812. Epub 2018 Jan 21.

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

Vivian Y Wu  1 , Kathryn R Fingar  2   3 , H Joanna Jiang  4 , Raynard Washington  5 , Andrew W Mulcahy  6 , Eli Cutler  7 , Gary Pickens  3
Affiliations

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

Vivian Y Wu et al. Health Serv Res. 2018 Oct.

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.

Keywords: Community hospitals; Medicaid expansion; medically uninsured; safety-net hospitals; state health policies; utilization.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(a) Changes in Inpatient Volume among Adults Aged 19–64 Years for SNHs and Non‐SNHs, 2013–2014. (b) Changes in Market Share of Inpatient Stays among Adults Aged 19–64 Years for SNHs and Non‐SNHs by Payer, 2013–2014. [Color figure can be viewed at http://www.wileyonlinelibrary.com/]

  1. Notes. Data came from the 2013–2014 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID) for nine states: AZ, CA, CO, IA, KY, MI, MN, NJ, and NY. Dashed line signifies the projected trend extrapolated from average quarterly percent changes during the preperiod. Q1‐13, first quarter, 2013; Q2‐13, second quarter, 2013; Q3‐13, third quarter, 2013; Q4‐13, fourth quarter, 2013; Q1‐14, first quarter, 2014; Q2‐14, second quarter, 2014; Q3‐14, third quarter, 2014; Q4‐14, fourth quarter, 2014; SNH, safety‐net hospital.

See this image and copyright information in PMC

References

    1. American Hospital Association . 2014. “Increasing Consumer Choice in Coverage and Care: Implications for Hospitals” [accessed on February 18, 2015]. Available at http://www.aha.org/research/reports/tw/14june-tw-consumerchc.pdf
    1. America's Essential Hospitals . 2014. “Vital Data: Results of America's Essential Hospitals’ Annual Hospital Characteristics Survey, FY 2012” [accessed on November 16, 2016]. Available at http://2c4xez132caw2w3cpr1il98fssf.wpengine.netdna-cdn.com/wp-content/up...
    1. Anderson, M. , Dobkin C., and Gross T.. 2012. “The Effect of Health Insurance Coverage on the Use of Medical Services.” American Economic Journal: Economic Policy 4 (1): 1–27.
    1. Armour, S. 2013. Patients Pay Before Seeing Doctor as Deductibles Spread. New York: Bloomberg.
    1. Barrett, M. , Lopez‐Gonzalez L., Hines A., Andrews R., and Jiang J.. 2014a. “An Examination of Expected Payer Coding in HCUP Databases” [accessed on February 18, 2015]. Available at https://www.hcup-us.ahrq.gov/reports/methods/2014-03.pdf

Publication types

LinkOut - more resources