Data analysis from the Colorado Hospital Association finds states that expanded their Medicaid programs under the Affordable Care Act have fewer self-pay patients and lower hospital charity care rates.
The association analyzed data from 465 hospitals across 30 states, 15 of which expanded Medicaid and 15 that did not. Much of the data came from 12 states, which include 90 percent of the hospitals surveyed with the remaining 18 states each having less than 10 hospitals per state.
The Medicaid proportion of patient volume at hospitals in states that expanded Medicaid increased substantially in the first quarter of 2014, according to a Colorado Hospital Association report. At the same time, the proportion of self-pay and overall charity care declined in expansionstate hospitals.
Between the first quarter of 2012 and the first quarter of 2014, Medicare charges remained steady in the 30 hospitals, regardless of whether states expanded or did not expand Medicaid, according to analysis of the data. But Medicaid charges in states that expanded the program went up 3.5 percent in the first quarter of 2014, while Medicaid charges in states that did not expand went up one-tenth of a percentage.
Additionally, self-pay volumes and charity care experienced the opposite effect, with hospitals in expansion states recording significant reductions in these at the start of 2014, according to the report. In the first quarter of 2014, Medicaid expansion states saw a 30 percent drop in average charity care per hospital compared to a year earlier, and total self-pay charges fell 25 percent.
This decline in self-pay and charity care, occurring in parallel with the growth in numbers of Medicaid beneficiaries, shows that previously uninsured patients are now enrolled in Medicaid, report authors conclude. Many hospitals provided on-site assistance to enroll eligible patients into Medicaid, promoting the recruitment of patients into Medicaid who otherwise would have self-paid or been provided with charity care.
The Colorado Hospital Association report, which emphasizes the preliminary nature of the findings and notes that the magnitude of further impacts remains to be seen, is available here.
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