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Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares.


ABSTRACT: OBJECTIVE:To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). 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 SNHs and non-SNHs. DATA COLLECTION METHODS:2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases. PRINCIPAL FINDINGS:On average per quarter postexpansion, SNHs and non-SNHs experienced similar relative decreases in uninsured stays (DID = -2.2 percent, p = .916). Non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs (DID = 13.8 percent, p = .041). For SNHs, the average decrease in uninsured stays (-146) was similar to the increase in Medicaid stays (153); privately insured stays were stable. For non-SNHs, the decrease in uninsured (-63) plus privately insured (-33) stays was similar to the increase in Medicaid stays (105). SNHs and non-SNHs experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined (DID = -16, p = .162). CONCLUSIONS:Postexpansion, non-SNHs experienced a greater percentage increase in Medicaid stays than did SNHs, which may reflect patients choosing non-SNHs over SNHs or a crowd-out of private insurance. More research is needed to understand these trends.

SUBMITTER: Wu VY 

PROVIDER: S-EPMC6153150 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Early Impact of the Affordable Care Act Coverage Expansion on Safety-Net Hospital Inpatient Payer Mix and Market Shares.

Wu Vivian Y VY   Fingar Kathryn R KR   Jiang H Joanna HJ   Washington Raynard R   Mulcahy Andrew W AW   Cutler Eli E   Pickens Gary G  

Health services research 20180121 5


<h4>Objective</h4>To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs).<h4>Study setting</h4>Nine Medicaid expansion states.<h4>Study design</h4>Differences-in-differences (DID) models compare payer-specific pre-post changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs.<h4>Data collection methods</h4>2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases.<h4>Principal findings</h4>On average per quarter po  ...[more]

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