Study examines Affordable Care Act's impact on uncompensated care
The decision by several states not to expand Medicaid health insurance for the poor may create unintended cuts for hospitals that provide uncompensated care, according to a study by John Graves, Ph.D., a Vanderbilt policy expert in the Department of Preventive Medicine.
Graves used financial data from U.S. hospitals and insurance data in each state to predict cuts in Medicare and Medicaid disproportionate share (DSH) funds paid to the nearly three-fourths of U.S. hospitals that serve low-income patients. The results, published in the Dec. 20 issue of the New England Journal of Medicine, put numbers behind the impact of funding changes and predict what the difference would be if Medicaid is, or is not, expanded in each state.
"Expanded insurance through the exchanges alone will trigger lower DSH payments to hospitals," Graves said. "The problem comes in states where much of the uncompensated care provided will remain the same if Medicaid is not expanded, yet DSH cuts will still occur. Hospitals will need to recoup these DSH losses either by providing less uncompensated care, or by shifting the costs onto everyone else."
As planned under the Affordable Care Act (ACA), Medicare DSH cuts will begin with a 75 percent across-the-board reduction in 2014 as new insurance exchanges come on line across the country. To reduce the impact of the cuts, the government has devised a calculation to add some DSH funds back, based on the proportion of citizens who are uninsured in each state. But because of the Supreme Court determination that states could not be compelled to expand Medicaid, who becomes covered in each state will vary widely.
Graves found that some states that do not expand Medicaid will be offering coverage to a greater number of people in their insurance exchanges, while continuing to leave most low-income, uninsured people without coverage. DSH cuts will still move forward in those states, placing a burden on hospitals that provide the most uncompensated care.
On the flip side, Graves found states that are planning to expand Medicaid coverage could end up covering as much as 60 percent of their uninsured citizens, significantly increasing the amount of hospital care covered by public and private insurers and offsetting the reduction in DSH funds.
Graves said of the top five states his calculations show will experience the most unintended DSH reductions, three—Texas, Louisiana and Florida—have already announced they will not expand Medicaid.
The federal government has set no time limit on states opting in or out of Medicaid expansions, but DSH cuts are currently set to begin in 2014.
Journal reference: New England Journal of Medicine
Provided by Vanderbilt University Medical Center
- Gov. Perry says Texas won't expand Medicaid Jul 10, 2012 | not rated yet | 0
- Expanding Medicaid to low-income adults leads to improved health, fewer deaths: study Jul 25, 2012 | not rated yet | 0
- Will safety net hospitals survive health reform? Sep 08, 2009 | not rated yet | 0
- Poorest Americans at risk if states opt out of Medicaid expansion Aug 06, 2012 | not rated yet | 0
- Feds rule on health care law's Medicaid expansion Dec 10, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Classical and Quantum Mechanics via Lie algebras
Apr 15, 2011 I'd like to open a discussion thread for version 2 of the draft of my book ''Classical and Quantum Mechanics via Lie algebras'', available online at http://lanl.arxiv.org/abs/0810.1019 , and for the...
- More from Physics Forums - Independent Research
More news stories
(HealthDay)—In 2008 to 2010, the prevalence of key health behaviors among U.S. adults varied, with about one in five adults current smokers and 62.1 percent overweight or obese, according to a report presented ...
Health 1 hour ago | not rated yet | 0
(HealthDay)—The overall health of Americans isn't improving much, with about six in 10 people either overweight or obese and large numbers engaging in unhealthy behaviors like smoking, heavy drinking or ...
Health 2 hours ago | not rated yet | 0
A federal court in San Francisco Tuesday struck down Arizona's ban on abortions after 20 weeks of pregnancy.
Health 2 hours ago | 5 / 5 (1) | 0
Children who are exposed to secondhand smoke in early childhood are more likely to grow up to physically aggressive and antisocial, regardless of whether they were exposed during pregnancy or their parents have a history ...
Health 4 hours ago | 1 / 5 (1) | 0
Most elite athletes consider doping substances "are effective" in improving performance, while recognising that they constitute cheating, can endanger health and entail the obvious risk of sanction. At the same time, the ...
Health 5 hours ago | not rated yet | 0
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
56 minutes ago | 5 / 5 (2) | 0 |
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
7 minutes ago | not rated yet | 0
A paper recently published in the New England Journal of Medicine and co-written by physicians and scientists at the University of Colorado School of Medicine finds that an important genetic risk factor for pulmonary fibros ...
34 minutes ago | not rated yet | 0
Using the Department of Defense Serum Repository (DoDSR), University of Cincinnati (UC) researchers have identified a number of biomarkers for inflammatory bowel disease (IBD), which could help with earlier diagnosis and ...
35 minutes ago | not rated yet | 0
By studying the roles two proteins, thrombospondin-1 and prosaposin, play in discouraging cancer metastasis, a trans-Atlantic research team has identified a five-amino acid fragment of prosaposin that significantly reduces ...
37 minutes ago | not rated yet | 0
Transparent information on the evidence supporting global recommendations on paediatric medicines should be easily accessible in order to help policy makers decides on what drugs to include in their national drug lists, according ...
57 minutes ago | not rated yet | 0