Impact of the Affordable Care Act Medicaid Expansions on Hospital Payer Mix and Uncompensated Care

Wednesday, June 15, 2016: 8:30 AM-10:00 AM
G50 (Huntsman Hall)
Sayeh S. Nikpay

The major coverage provisions of the Affordable Care Act (ACA) have resulted in historic gains coverage, in large part due to state-based Medicaid expansions to low-income, childless adults. These changes have financial implications for hospitals, where an estimated $60B of unreimbursed health care costs were incurred in 2013. With the hope that increased Medicaid patients would translate to reductions in uncompensated care and improved financial position, hospitals argued forcefully for state Medicaid expansions. The purpose of this session is to explore the impact of the ACA Medicaid expansions on hospitals, including payer mix, uncompensated care, and measures of financial status. Comparing hospitals in states that expanded Medicaid to those that did not, Nikpay, Buchmueller, and Levy use Medicare hospital cost reports to estimate changes in Medicaid discharges and revenue, uncompensated care, and hospital operating margins in the first year of coverage expansion. In addition to hospital cost reports, DeLeire uses state hospital discharge databases and data from several individual hospital chains to forecast changes in uncompensated care for 2015 and 2016. Finally, using a plausibly more robust identification strategy, Sabik and Cunningham leverage the county-level roll-out of the early ACA Medicaid expansion in California to estimate the impact on hospital payer mix for safety net hospitals in two hospital discharge datasets (the National Inpatient Sample and the California Office of Statewide Health Planning and Development dataset). Our discussants will include Misha Dworsky, Ph.D., Ari Friedman, Ph.D., M.D., and Susan Camillieri.

8:50 AM
Impact of insurance Expansion on Hospital Uncompensated Care Costs in 2015

Author(s): Thomas DeLeire

Discussant: Susan Camilleri

9:10 AM
The Effects of Early Medicaid Expansion in California on Inpatient Utilization of Safety Net Hospitals

Author(s): Lindsay M Sabik; Ali Bonakdar; Peter Cunningham

Discussant: Ari B. Friedman