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Early Impact of the Affordable Care Act Coverage Expansion on Safety‐Net Hospital Inpatient Payer Mix and Market Shares
Author(s) -
Wu Vivian Y.,
Fingar Kathryn R.,
Jiang H. Joanna,
Washington Raynard,
Mulcahy Andrew W.,
Cutler Eli,
Pickens Gary
Publication year - 2018
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12812
Subject(s) - medicaid , quarter (canadian coin) , safety net , health insurance , patient protection and affordable care act , medicine , percentage point , actuarial science , health care , business , finance , environmental health , economics , archaeology , history , economic growth
Objective To examine the impact of the Affordable Care Act's coverage expansion on safety‐net hospitals ( SNH s). 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 SNH s and non‐ SNH s. Data Collection Methods 2013–2014 Healthcare Cost and Utilization Project State Inpatient Databases. Principal Findings On average per quarter postexpansion, SNH s and non‐ SNH s experienced similar relative decreases in uninsured stays ( DID = –2.2 percent, p = .916). Non‐ SNH s experienced a greater percentage increase in Medicaid stays than did SNH s ( DID = 13.8 percent, p = .041). For SNH s, the average decrease in uninsured stays (–146) was similar to the increase in Medicaid stays (153); privately insured stays were stable. For non‐ SNH s, the decrease in uninsured (–63) plus privately insured (–33) stays was similar to the increase in Medicaid stays (105). SNH s and non‐ SNH s experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined ( DID = –16, p = .162). Conclusions Postexpansion, non‐ SNH s experienced a greater percentage increase in Medicaid stays than did SNH s, which may reflect patients choosing non‐ SNH s over SNH s or a crowd‐out of private insurance. More research is needed to understand these trends.