Medicaid Expansion Helps Save Hospitals

Hospitals in states that took advantage of the Affordable Care Act to expand their Medicaid programs are six times less likely to close than hospitals in non-expansion states.

And the impact of Medicaid expansion is even more beneficial for hospitals that serve rural communities.

These are among the new findings in a new study that examines the effect of Medicaid expansion on hospital finances and hospital closures.  Among those findings,

We found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion.

According to the study, these hospitals, as a result of Medicaid expansion, served fewer uninsured patients and provided less uncompensated care than they previously had, thereby improving their financial health.  This effect has been especially pronounced in communities with especially large numbers of uninsured patients – communities like those served by urban safety-net hospitals.

For this reason, the study’s authors conclude that

Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals. Our results imply that reverting to pre-ACA eligibility levels would lead to particularly large increases in rural hospital closures. Such closures could lead to reduced access to care and a loss of highly skilled jobs, which could have detrimental impacts on local economies.

 To learn more, go here, to the Health Affairs web site, to see the study “Understanding The Relationship Between Medicaid Expansions And Hospital Closures.”

The Continued Need for Medicaid DSH

While the Affordable Care Act has greatly increased the number of Americans with health insurance and reduced the demand for uncompensated care from hospitals, many hospitals still see significant numbers of uninsured patients.

Some of those patients simply have not taken advantage of the health reform law’s creation of easier access to affordable insurance while others live in states that have not expanded their Medicaid programs.

Hospitals that care for especially large numbers of such uninsured patients qualify for Medicaid disproportionate share hospital payments, commonly referred to as Medicaid DSH.  The purpose of these payments is to help these hospitals with the unreimbursed costs they incur caring for such patients.

The Affordable Care Act calls for reducing Medicaid DSH payments to hospitals.  Many hospitals and hospital groups – including the National Association of Urban Hospitals – oppose this cut and are asking Congress to block its implementation.

The Commonwealth Fund recently published a commentary calling for delaying scheduled Medicaid DSH cuts.  Go here to see the article “Keep Harmful Cuts in Federal Medicaid Disproportionate Share Hospital Payments at Bay.”

 

House Members Seek Delay of DSH Cuts

221 members of the House of Representatives have written to House leaders asking them to delay cuts in Medicaid disproportionate share payments (Medicaid DSH) that are scheduled to begin on October 1.

The cuts, mandated by the Affordable Care Act, have already twice been delayed by Congress, both times for two years, and now, a majority of House members have written to House speaker Paul Ryan and minority leader Nancy Pelosi asking them to advance legislation to delay Medicaid DSH cuts once again.

The purpose of Medicaid DSH payments is to help hospitals that serve especially large numbers of low-income patients to absorb some of the losses they incur serving uninsured and underinsured people.  All private safety-net hospitals receive Medicaid DSH payments and NAUH recently wrote to House members asking them to sign this letter asking Mr. Ryan and Ms. Pelosi.

See the letter to House leaders here and see NAUH’s letter to House members here.

NAUH Urges House to Delay Medicaid DSH Cuts

The House of Representatives should delay the proposed implementation of major cuts in Medicaid disproportionate share (Medicaid DSH) allotments to the states.

The reduction of Medicaid DSH allotments, mandated by the Affordable Care Act, has already been delayed twice by Congress, and now, a bipartisan letter is being circulated among House members asking House Speaker Paul Ryan and House minority leader Nancy Pelosi to move legislation to delay the Medicaid DSH cuts again for another two years.

In its message, NAUH has asked House members to sign onto the letter, which is being circulated by Representatives Eliot Engel (D-NY), John Culberson (R-TX), and Steve Palazzo (R-MS).

All private safety-net hospitals receive Medicaid DSH payments and all consider them a vital source of revenue to help them serve the low-income residents of the communities in which they are located.

Go here to see NAUH’s message to House members.

NAUH Comments on Proposed Cut of Medicaid DSH Payments

NAUH has expressed its opposition to a proposed change in how the federal government allocates Medicaid disproportionate share (Medicaid DSH) funding to states.

In a formal comment letter to the Centers for Medicare & Medicaid Services, which proposed the change in state Medicaid DSH allotments, NAUH wrote that it opposed CMS’s proposed division of the cuts between so-called “low-DSH states” and “non-low-DSH states,” maintaining that non-low-DSH states would, under the CMS proposal, bear too great a share of the overall reductions of state Medicaid DSH allotments.

The Affordable Care Act requires a reduction of federal Medicaid DSH spending based on the expectation that improved access to health insurance would result in fewer uninsured Americans – as it has.  For the past several years Congress delayed implementation of this requirement but its most recent delay expires in 2018 and in July CMS published a proposed rule outlining how it would implement the statutory requirement.

NAUH’s objection is to how CMS proposes implementing that reduction.

See NAUH’s formal comment letter to CMS here.

ACA Reduced Disparities in Access to Care

The Affordable Care Act has reduced socioeconomic disparities in access to health care in the U.S.

According to a new study published in the journal Health Affairs,

Health care access for people in lower socioeconomic strata improved in both states that did expand eligibility for Medicaid under the ACA and states that did not. However, gains were larger in expansion states. The absolute gap in insurance coverage between people in households with annual incomes below $25,000 and those in households with incomes above $75,000 fell from 31 percent to 17 percent (a relative reduction of 46 percent) in expansion states and from 36 percent to 28 percent in nonexpansion states (a 23 percent reduction). This serves as evidence that socioeconomic disparities in health care access narrowed significantly under the ACA.

Addressing socioeconomic barriers to access to care has long been one of the major roles private safety-net hospitals play in their individual communities.

Learn more about how the study was conducted and what it revealed in the article “The Affordable Care Act Reduced Socioeconomic Disparities In Health Care Access,” which can be found here, on the Health Affairs web site.

Behavioral Health Services in Medicaid Expansion States

The U.S. Government Accountability Office has performed a limited study of the utilization of Medicaid behavioral health services in Medicaid expansion states.

The study, based on data from New York, Washington, Iowa, and West Virginia, found that the two most heavily utilized behavioral health services were diagnostic and psychotherapy services and that more than two-thirds of behavioral health patients were prescribed anti-depressants.  More people sought help for mental health challenges that for substance abuse problems.

Medicaid officials in the selected states concluded that enrollment in Medicaid enhanced access to behavioral health care.

Learn more about the study’s findings in the GAO report Medicaid Expansion:  Behavioral Health Treatment Use in Selected States in 2014, which can be found here.

Hospital Uncompensated Care Down

As was surely expected, reforms introduced through implementation of the Affordable Care Act have driven down uncompensated care costs for many hospitals.

How much?

A new study published by the Commonwealth Fund offers the following findings:

  • uncompensated care declines in expansion states are substantial relative to profit margins;
  • for every dollar of uncompensated care costs hospitals in expansion states had in 2013, the Affordable Care Act erased 41 cents by 2015; and
  • Medicaid expansion reduced uncompensated care burdens for safety-net hospitals that are not made whole by Medicaid disproportionate share payments (Medicaid DSH).

Learn more, including how the decline in uncompensated care costs affected different kinds of hospitals in different kinds of states, in the report “The Impact of the ACA’s Medicaid Expansion on Hospitals’ Uncompensated Care Burden and the Potential Effects of Repeal,” which can be found here, on the Commonwealth Fund’s web site.

More Insured Didn’t Affect Access

When the Affordable Care Act was debated and then passed, some observers questioned whether the health care system had enough providers to care for the millions of additional people who would be gaining coverage through the reform law.  In particular, some worried that those who already had insurance would find their access to care reduced because of the new, increased demand for care among the newly insured.

Those fears appear to have been groundless.

 In a new study published in the journal Health Affairs, researchers concluded that

 …we found no consistent evidence that increases in the proportion of adults with insurance at the local-area level affected access to care for adults residing in the same area who already had, and continued to have, insurance.

This finding even applies to people who live in health care professional shortage areas and those covered by Medicaid.

Learn more by going here to see the study “Growing Insurance Coverage Did Not Reduce Access To Care For The Continuously Insured.”

 

Health Reform Helps Hospitals in Medicaid Expansion States

The Affordable Care Act’s enhancement of access to health insurance, whether through Medicaid expansion or the subsidization of insurance premiums for working-class and some middle-class Americans, has improved the financial health of hospitals.

Especially hospitals in Medicaid expansion states.

According to a new report from the Urban Institute,

Using data through fiscal year 2015, this new analysis finds that the Medicaid expansion under the ACA increased Medicaid revenue by $5.0 million per hospital, reduced costs of uncompensated care by $3.2 million per hospital, and improved average operating margins by 2.5 percentage points. This study also finds that the financial benefits of the Medicaid expansion on hospitals’ profit margins were strongest for small hospitals, for-profit and non-federal-government-operated hospitals, and hospitals located in nonmetropolitan areas.

To learn more, go here to find the new Urban Institute report “How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data.”