Association Between the 2014 Medicaid Expansion and US Hospital Finances

Blavin, Fredric

doi:10.1001/jama.2016.14765

Cited by 85 publications

(88 citation statements)

References 7 publications

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“…Consistent with prior research, the results in Table suggest that the Medicaid expansion was strongly correlated with a reduction in uncompensated care . The coefficients on the difference‐in‐differences estimators in Table , Expand*2014 and Expand*2015, are negative and statistically significant at the 0.01 level.…”

Section: Methodssupporting

confidence: 83%

Hospital uncompensated care and patient experience: An instrumental variable approach

Camilleri

Diebold

2019

Health Services Research

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Objective Examine the endogenous relationship between uncompensated care and hospital patient experience scores. Data Sources/Study Setting The Hospital Consumer Assessment of Healthcare Providers and Systems Survey, CMS Healthcare Cost Report Information System, and the US Census Bureau. Study Design The exogenous change in uncompensated care caused by the 2014 Medicaid expansion was exploited to measure the effect of uncompensated care on patient experience scores using a 2SLS regression with instrumental variables approach. Data Collection/Extraction Methods U.S. general, short‐term hospitals whose DSH status remained constant and had nonmissing data for 2011‐2015, which totaled 969 unique hospitals per year. Principal Findings The effect of uncompensated care on patient experience was in the predicted direction, with three of the 10 measures being statistically significant. A one percentage point increase in uncompensated care costs resulted in a 0.25‐0.50 percentage point decrease in select patient experience scores. Conclusions Results indicate a weak relationship between uncompensated care and patient experience scores, as a reduction in uncompensated care is related to quality improvement for some hospitals. These findings have implications for hospitals as they navigate changing reimbursement structures and policy makers considering changes to Obama‐era health care reforms.

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Section: Methodssupporting

confidence: 83%

Hospital uncompensated care and patient experience: An instrumental variable approach

Camilleri

Diebold

2019

Health Services Research

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“…Early research comparing hospitals in states that did and did not expand Medicaid indicates that the expansion led to a reduction in uninsured patients and an increase in Medicaid patient volume (Hempstead and Cantor ; Nikpay et al ; Nikpay, Buchmueller, and Levy ). These changes in patient payer mix coincided with significant reductions in hospital expenditures on uncompensated care (Blavin ; Camilleri ; Dranove, Garthwaite, and Ody ; Nikpay, Buchmueller, and Levy ).…”

Section: Introductionmentioning

confidence: 96%

“…The only published study to date to examine the impact of Medicaid expansion on hospital margins finds only marginally significant improvements in operating margins in expansion states relative to nonexpansion states (Blavin ). That study, like others focusing exclusively on changes in hospital uncompensated care (Camilleri ; Dranove, Garthwaite, and Ody ), is based on a simple comparison of states that did and did not implement the Medicaid expansion in January 2014.…”

Section: Introductionmentioning

confidence: 99%

Heterogeneous Effects of the Aca Medicaid Expansion on Hospital Financial Outcomes

Rhodes

Buchmueller

Levy

et al. 2019

Contemporary Economic Policy

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This study examines the effect of the Affordable Care Act's Medicaid expansion on hospital financial outcomes. A key innovation relative to prior studies is that we explicitly account for heterogeneity across states in the timing and extent of the expansion as well as across hospital types. We find that Medicaid expansion led to a decrease in uncompensated care expenditures and an increase in average operating margins. The effects were larger in states where the Medicaid expansion led to a greater increase in program eligibility. Operating margins improved most for public hospitals and facilities located in rural areas. (JEL I11, I13, I18)

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“…A major motivation for the ACA was to reduce uncompensated care costs to hospitals, and studies suggest that this goal was achieved. Nikpay and colleagues () find that the Medicaid expansions were associated with a nearly 50 percent decline in uninsured hospital stays, and Blavin () estimated a 30 percent decline in hospital uncompensated care. At the same time, many of the increased hospitalizations were paid for by Medicaid, which typically reimburses at a lower level than private insurance or Medicare; the law also included a reduced rate of growth of Medicare reimbursement.…”

Section: Effects Of the Aca On Health Care Providersmentioning

confidence: 99%

The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

Gruber¹,

Sommers²

2019

J Policy Anal Manage

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As we approach the tenth anniversary of the passage of the Affordable Care Act, it is important to reflect on what has been learned about the impacts of this major reform. In this paper, we review the literature on the impacts of the ACA on patients, providers, and the economy. We find strong evidence that the ACA's provisions have increased insurance coverage. There is also a clearly positive effect on access to and consumption of health care, with suggestive but more limited evidence on improved health outcomes. There is no evidence of significant reductions in provider access, changes in labor supply, or increased budgetary pressures on state governments, and the law's total federal cost through 2018 has been less than predicted. We conclude by describing key policy implications and future areas for research.

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Association Between the 2014 Medicaid Expansion and US Hospital Finances

Cited by 85 publications

References 7 publications

Hospital uncompensated care and patient experience: An instrumental variable approach

Hospital uncompensated care and patient experience: An instrumental variable approach

Heterogeneous Effects of the Aca Medicaid Expansion on Hospital Financial Outcomes

The Affordable Care Act's Effects on Patients, Providers, and the Economy: What We've Learned So Far

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