Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States, Health Affairs
We examine how the Affordable Care Act (ACA)’s coverage expansions changed the burden of uncompensated care at a large, diverse sample of hospitals. We estimate that in Medicaid expansion states, uncompensated care decreased from 4.1 to 3.1 percentage points of operating costs. Reductions in uncompensated care costs in Medicaid expansion states were larger at hospitals with higher pre-ACA uncompensated care burdens and at hospitals located in markets where we predict more people gained Medicaid eligibility. Our estimates suggest that uncompensated care costs would have decreased from 5.7 to 4.0 percent of operating costs in non-expansion states if they had expanded Medicaid, whereas without the expansions they remained effectively unchanged. Thus, while the ACA decreased the variance in uncompensated care costs across hospitals within Medicaid expansion states, the difference in uncompensated care costs across expansion and non-expansion states has meaningfully increased.
Dranove, David, Craig Garthwaite, and Christopher Ody. 2016. Uncompensated Care Decreased At Hospitals In Medicaid Expansion States But Not At Hospitals In Nonexpansion States. Health Affairs. 35(8): 1471-1479.