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

Published in: Health Services Research [Epub January 2018]. doi:10.1111/1475-6773.12812

Posted on RAND.org on February 14, 2018

by Vivian Y. Wu, Kathryn R. Fingar, H. Joanna Jiang, Raynard Washington, Andrew W. Mulcahy, Eli Cutler, Gary Pickens

Read More

Access further information on this document at John Wiley & Sons, Ltd

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.