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.”

NAUH Expresses Views on Health Reform Proposal

NAUH does not support the American Health Care Act in its current form, the organization told members of the House of Representatives in a letter it sent yesterday.

In its letter, NAUH noted that the recently proposed AHCA would result in millions of Americans, many of them Medicaid beneficiaries and low-income individuals and families, losing their health insurance over the next ten years.  Private safety-net hospitals serve especially large numbers of these patients.

In addition, the bill inadequately indexes future growth in federal Medicaid spending; proposed two years of reduced Medicaid disproportionate share (Medicaid DSH) payments in some states; and calls for reduced federal funding for the Affordable Care Act’s Medicaid expansion population in a manner that NAUH believes could lead to some combination of tightened Medicaid eligibility requirements, reduced benefits, and reduced provider payments.

For these reasons, NAUH does not support the AHCA in its current form.

In its letter, NAUH also expresses hope that Congress will consider addressing these issues when it refines and improves the bill.

The ACHA proposal would repeal and replace the Affordable Care Act.

See NAUH’s letter to Congress here.

NAUH Weighs in on American Health Care Act

In a letter to members of Congress and selected congressional staff, NAUH shared its perspective on the American Health Care Act, the legislation Congress is considering as a means of repealing and replacing the Affordable Care Act.

The letter highlights several aspects of the proposed law NAUH appreciates and points to aspects with which it disagrees, including its failure to restore Medicare DSH payments to pre-Affordable Care Act levels, its continuation of Medicaid DSH cuts in Medicaid expansion states for two more years, and a methodology for indexing future growth in the program’s spending that NAUH believes will leave Medicaid underfunded in the future.

Find the complete letter here, on the NAUH web site.

 

Comparing “Repeal and Replace” Proposals

How can you keep score while Congress considers multiple proposals to repeal and replace the Affordable Care Act?

The Kaiser Family Foundation has just created a new tool that enables users to compare and contrast all of the current repeal and replace proposals:  you pick the proposals you want to compare and you select the aspects of those proposals that interest you.

Find this new interactive tool here, on the web site of the Kaiser Family Foundation.

 

Budget Reconciliation Explained

The Republican Congress may use the federal budget reconciliation process to repeal some aspects of the Affordable Care Act.

But what is the budget reconciliation process and how does it work?

Kaiser Health News has created a brief video, with an accompanying transcript, that explains. Find that video here.

ACA Replacement?

While both the Trump administration and Congress insist that they will repeal and replace the Affordable Care Act, neither has yet provided information about what that replacement might look like.

priceBut one place worth looking for a possible glimpse into the future is the Affordable Care Act replacement plan proposed by Rep. Tom Price (R-GA), President Trump’s nominee to serve as Secretary of the Department of Health and Human Services.

In 2015, Rep. Price proposed the Empowering Patients First Act as a vehicle for replacing the Affordable Care Act. While the bill was not adopted by Congress at the time, Dr. Price should soon be in a position to exert meaningful influence over the manner in which the Trump administration and Congress go about replacing the Affordable Care Act.

The Kaiser Family Foundation has prepared a summary of Dr. Price’s 2015 proposal. Go here to see that summary and to find a link to the legislation itself.