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ACA Medicaid Expansion Leads to Decreased Uninsurance Rates

By Sara Heath

As a result of Medicaid expansion as a part of the Affordable Care Act, many previously uninsured patients are shifting to Medicaid as their health insurer. A recent study by Kaiser Family Foundation shows that this shift in payer is decreasing the number of uninsured patients in states that have adopted Medicaid expansion.

medicaid expansion in affordable care act decreases uninsured hospital patients

The study, authored by Robin Rudowitz and Rachel Garfield, examines 10 states which have adopted Medicaid expansion and 6 states which have not. Overall, the study reports that through the second quarter of 2014, expansion states saw an increase in adult hospitalizations in which the expected payer was Medicaid, and a decrease in hospitalizations in which the patients were uninsured. Rudowitz and Garfield reported that this disparity was not the norm, and that typically rates of Medicaid patients and uninsured patients mirror each other.

Overall, expansion states saw an increase in Medicaid patients of 16.3 percent, and a decrease of uninsured patients of 36.9 percent. Conversely, non-expansion states saw a 0.5 percent increase in Medicaid patients and a 2.9 percent decrease in uninsured patients. This suggests that in states where Medicaid services have been expanded, more individuals are taking advantage of those services and enrolling in health insurance coverage.

Rudowitz and Garfield also reported changes in Medicare patients and patients with private health insurance. Both expansion and non-expansion states saw a decline in Medicare patients of 7.7 percent and 5.3 percent respectively. Hospitals also saw a decline in patients with private health insurance, with a 3.8 percent decrease for both expansion and non-expansion states.

Change in in-patient hospital stays for expansion states was also sorted by condition. This data set showed a serious decrease in patients who were uninsured seeking care for asthma, coronary heart failure, diabetes, and surgical care. However, Medicaid payers saw an increase in patient stays for all of these conditions. Most notably, there was a 34.5 percent increase in diabetes patients whose expected payer was Medicaid.

However, non-expansion states saw a decrease in Medicaid patients for most of these conditions, the study reports. For asthma patients, non-expansion states saw a 8.1 percent decrease in Medicaid patients, and for surgical care, a 1.8 percent decrease. Non-expansion states did see a 4.3 percent increase in coronary heart failure patients using Medicaid, however it should also be noted that non-expansion states also saw a 15.3 percent spike in coronary heart failure patients who were uninsured.

Overall, Rudowitz and Garfield say, it will be important to keep an eye on how these numbers change as Medicaid expansion is adopted in more states. The authors expect the disparities between expansion and non-expansion states to close over time as payers adjust their models. Additionally, Rudowitz and Garfield state that it will be important to examine how hospital finances fare throughout this transition as an increasing number of patients enroll in Medicaid.


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