Medicaid expansion tied to drop in uninsured hospital discharges

Before the implementation of the Affordable Care Act, the number of Medicaid and uninsured hospital discharges in states that both expanded and did not expand Medicaid changed in a similar pattern each quarter. But beginning in 2014, new trends indicate that coverage expansion may lead to decreases in uncompensated care for the uninsured.

The findings, compiled by the Kaiser Family Foundation, look at 10 states that expanded Medicaid, and six that did not by the second quarter of 2014. Here are some highlights from the report:

  • While inpatient stays declined by 3.4 percent for a typical expansion state from 2013 to 2014, Medicaid inpatient stays increased by 16.3 percent, and uninsured stays decreased by 36.9 percent.
  • In a typical non-expansion state, inpatient stays declined by 4.0 percent, while Medicaid inpatient stays experienced a 0.5 percent increase, and uninsured inpatient stays decreased by 2.9 percent.
  • Mental health stays accounted for 5.8 percent of adult hospital stays in the second quarter of 2014.
  • Expansion states experienced a 1.5 percent decrease in mental health inpatient stays but saw a 36.5 percent increase in Medicaid mental health inpatient stays, and a 44 percent decline in uninsured stays for mental health.

As KFF points out, the last three quarters of 2014 did not demonstrate stark differences between expansion and non-expansion states, compared with the earlier months of last year. This is likely because payers were experiencing changes as individuals switched coverage due to Medicaid expansion options.

In conclusion, the analysis notes that hospitals in expansion states experienced large shifts in payer mix between Medicaid and uninsured, as most hospital discharges are covered by other payers such as Medicare or private insurance.

Research also has tied Medicaid expansion to greater drops in the number of uninsured individuals, FierceHealthPayer has reported. In non-expansion states, meanwhile, the higher cost of uncompenstated care roughly equals out to how much those states would have spent on expanding coverage for lower-income individuals. 

For more:
- here's the report