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
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Access further information on this document at John Wiley & Sons, LtdThis 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 article was published outside of RAND. The full text of the article can be found at the link above.
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