Medicaid expansion under ACA reduced uninsured hospital stays in 2014: 5 things to know

The 29 states that expanded Medicaid by the first quarter of 2015 saw the most significant effects of healthcare coverage expansion — including increased access to physicians and fewer cost-related barriers to care — compared with non-expansion states, according to a recent Health Affairs report.

Here are five findings from the report.

1. States that expanded Medicaid in 2014 (Arizona, California, Colorado, Hawaii, Iowa, Kentucky, Minnesota, New Jersey and New York) experienced significant decreases in uninsured hospital stays and increases in Medicaid-covered stays.
2. The states that did not expand eligibility for Medicaid (Florida, Georgia, Indiana, Missouri, Virginia and Wisconsin) saw very little change in the mix of payers for inpatient care.
3. In expansion states, the data show a dramatic rift in the trends in the proportion of people with Medicaid and the uninsured in the first two quarters of 2014. From the third quarter of 2013 and the second quarter of 2014, expansion states experienced a 7 percentage point rise in the Medicaid share and a 6 percentage point drop in the uninsured share. These changes represent a 20 percent increase and 50 percent decrease in the Medicaid and uninsured discharge rates, respectively.
4. The proportions of Medicaid and uninsured inpatients gradually increased in the few years preceding 2014, while the proportion of inpatients with private coverage slowly decreased. This affirms pre-established trends in insurance coverage for the general population.
5. Before Medicaid expansion, the states that would later expand Medicaid eligibility had higher shares of Medicaid beneficiaries and lower shared of uninsured people, compared to non-expansion states. However, trends in inpatient payer mix were similar in both expansion and non-expansion states.

Health Affairs used newly available data on trends in payer mix for non-Medicare adult inpatient hospital stays from HCUP Fast Stats, a new online database query tool from the Agency for Healthcare Research and Quality, to elucidate this discussion.