Safety-Net Hospitals See Fewer Uninsured Under ACA, Study Finds
Safety-net hospitals are seeing fewer uninsured patients because of new coverage options available through the Affordable Care Act, according to an Urban Institute study published in Health Affairs, USA Today/Kaiser Health News reports.
According to the study, hospitals provided as much as $45 billion in uncompensated care in 2013, of which about 65% was paid for by government programs.
Because hospitals are treating fewer uninsured patients, they also are experiencing increased revenues, according to the report.
For example, Seattle-based Harborview Medical Center, the area's largest safety-net provider, saw its proportion of uninsured patients decline from 12% in 2013 to 2% this past spring. The drop off is expected to increase revenue by $20 million in 2014.
According to Harborview officials, patients increasingly are using primary care physicians instead of relying on emergency departments for care.
Meanwhile, Colorado's Denver Health and the University of Arkansas for Medical Sciences Hospital also saw their proportions of uninsured patients decline by almost 50% this year.
UAMS CEO Roxane Townsend said that about 80% of her system's newly insured Medicaid beneficiaries previously had been uninsured. In addition, she noted that the system had seen a "significant" drop in ED use, from 6,000 visits in the first three months of 2013 to 4,000 visits in the same period this year.
Meanwhile, Denver Health officials said that an increase in insured patients since January seems to also be increasing the number of people seeking primary care at its facilities. Specifically, patient visits to Denver Health primary care centers have increased by 14% this year, while ED visits have declined by 2%. Further, officials noted that patient visits for substance use disorders and mental health services have risen by nearly 50%.
Other Providers Benefit, Too
According to the study, safety-net hospitals are not the only facilities benefitting from the ACA. Investor-owned hospital companies such as Community Health Systems, HCA and Tenet Healthcare also have reported increases in insured patients. The groups said the number of uninsured patients dropped by one-third during the first quarter of this year at hospitals in states that have expanded Medicaid under the ACA. In comparison, HCA said the number of uninsured patients at its hospitals in states that have not expanded their Medicaid programs increased by 6% (Galewitz, USA Today/Kaiser Health News, 5/27).
Potential Funding Gaps Ahead, but Final Effects Unknown
Meanwhile, the study warned that reductions to disproportionate share hospital payments in Medicaid and Medicare under the ACA could create funding gaps for individuals who remain uninsured, The Hill reports.
According to the report, providers in 2013 spent about $85 billion to cover the cost of uncompensated care, but the government offset 65% of that expense. However, under the ACA, Medicaid DSH payments are expected to decrease by 50% and Medicare DSH payments are expected to decline by 28%. Those reductions could cause significant financial challenges to providers, particularly in states that have not expanded their Medicaid programs, according to the study.
The report noted that it is not yet clear how the reductions will affect providers who treat uninsured patients, but concluded, "It will be essential for federal, state and local policy makers, providers and consumer advocates to monitor how these changes affect the provision of uncompensated care for uninsured people -- a group expected to number 30 million in 2017" (Al-Faruque, The Hill, 5/27).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.