The Colorado study compared data from 450 hospitals collected this past July by the association DATABANK program. It studied hospitals in 13 states where Medicaid coverage has been expanded to include adults with incomes up to 138% of the federal poverty level and from 12 states where Medicaid has not been expanded.
“Hospitals located in expansion states are serving greater numbers of Medicaid patients, many needing care for advanced chronic health conditions that were previously left untreated,” Steven Summer, association president and CEO, said in a news release. “These findings confirm that individuals who previously had no insurance coverage are now seeking and receiving healthcare services—and their needs are great.”
In states where Medicaid has been expanded, the percentage of hospital charges reimbursed by Medicaid has grown from 15.1% in the second quarter of 2013 to 19.1% in the second quarter of 2014. In nonexpansion states, the percentage increased from 13.1% to 13.6%. The association said this unexpected growth was most likely linked to the “woodwork effect,” where previously unenrolled-but-eligible patients signed up for Medicaid coverage after learning about the program.
Self-pay in the Medicaid expansion states studied fell from 4.6% of all charges to 2.3%. Charges paid by commercial plans dropped from 41.2% to 39.2%. In the nonexpansion states studied, self-pay dropped from 6.4% of charges in the second quarter of 2013 to 5.2% of charges in the second quarter of 2014. Average charity care for hospitals in expansion states fell from $2.8 million to $1.5 million during the study period. Hospitals in nonexpansion states also provided less charity care, but the difference was much smaller: $3.4 million in the second quarter of 2014 compared with $4 million in the second quarter of 2013.
For Colorado-specific statistics, the report used first-quarter numbers from 62 hospitals in the state. The association reported that the number of emergency-department visits for all types of reimbursement was up more than 10.6%, rising to 446,451 in first quarter 2014 from 403,533 in the first quarter of 2013. The number of emergency-department visits by Medicaid beneficiaries increased by almost 38.2%, from 114,221 to 157,829.
Dr. Bill Burman, director of Denver Public Health that is part of the Denver Health safety net system, said his organization has had significant success guiding newly covered Medicaid patients into primary-care settings and specialists and has not seen the ED bump observed in the hospital association's report.
Denver Health has had 28,000 new Medicaid patients, and the proportion of Denver Health's patients who are covered by Medicaid has gone from about one-third to just under a half, Burman said. Many of these individuals are not “new patients,” but rather previously uninsured patients who now have coverage.
“Certainly, we've seen a dramatic increase in the proportion of our Medicaid patients,” Burman said, but visits to the Denver Health hospital emergency department and urgent-care center are down by more than 2.6% in the first half of 2014 compared with the first half of 2013. Primary-care visits are up 13% and specialty care visits are up 10%.
“People are getting care in the place we want them to—and not necessarily the emergency room.” He added, however, that when Massachusetts expanded coverage in the state, it saw an initial increase in emergency room visits (PDF) but this figure eventually decreased by 8% (PDF).
The study, Burman said, should serve as an important piece of information for states still wrestling with whether they should expand Medicaid.
“Without question it's good for individuals,” he said. “It's also good for the community and for the business climate.”
The expansion states included in the study were Arkansas, Colorado, Connecticut, Delaware, Hawaii, Iowa, Maryland, New Mexico, Ohio, Oregon, Rhode Island, Washington and West Virginia. The nonexpansion sates were Alaska, Idaho, Indiana, Kansas, Louisiana, Michigan, Mississippi, Montana, Nebraska, New Hampshire, Oklahoma and Pennsylvania. (The CMS approved the Pennsylvania Medicaid expansion plan last week.)
Virginia Gov. Terry McAuliffe, a Democrat, announced Monday that he had given up on trying to expand his state's program without the cooperation of the Republican-led Legislature.
Follow Andis Robeznieks on Twitter: @MHARobeznieks