Medicaid 2.0

Ceci ConnollyWhile fierce debate continues to envelop much of the Affordable Care Act, financial data for many of the nation’s health systems reveal one clear fact: the optional Medicaid expansion has resulted in hospital haves and have nots.

An analysis by PwC’s Health Research Institute (HRI) of newly released earnings and patient volume data shows a clear financial split between healthcare providers operating in states that expanded Medicaid and those that have not. The law as written would have provided Medicaid coverage to every American earning less than 138% of the federal poverty level ($16,105 for an individual). But a June 2012 Supreme Court ruling made the expansion optional for states, creating a patchwork of coverage.

Health systems and physician groups delivering care in the 26 states and the District of Columbia that have embraced the federally-funded expansion have reported a significant rise in patient volumes and paying consumers and a measureable reduction in uncompensated care levels.

This year alone LifePoint Hospitals has seen a 30.3% reduction in its uninsured and charity care patients, according to filings with the Securities and Exchange Commission. Tenet Healthcare, which operates in five Medicaid expansion states, saw uninsured and charity care admissions decline by 46% in the expansion states, coupled with a 20.5% increase in Medicaid inpatient admissions in those same states, according to an HRI analysis which will be released next week.

In all, HRI analyzed financial data from the nation’s five largest for-profit health systems—HCA Holdings, LifePoint, Tenet, Community Health Systems and Universal Health Services, representing 538 hospitals in 35 states. Our team also reviewed data from several mid-sized hospitals, government reportsand industry surveys.

As Chip Kahn, president of the Federation of American Hospitals told HRI: “It’s logical…the expansion has had a material effect on those areas.”

Medicaid admissions in expansion states increased by a range of 10.4% to 32% in the country’s three largest health systems since the start of the year. Uninsured or “self-pay” admissions, which typically represent a large share of uncompensated care, fell about 47% during the first half of this year for the same three systems.

Tennessee-based Community Health executives, put the impact of the ACA’s coverage expansion into dollars, reporting that the surge in paying customers accounted for about $45 million in revenue so far this year and they expect it to be an additional $40 million by the end of 2014.

The expansion had a similar impact on doctors. Primary care physicians, surgeons and other specialists in expansion states saw more Medicaid patients during the first three months of 2014 than they did in the previous year, according to a report this summer by Robert Wood Johnson Foundation and AthenaHealth.

Some governors have resisted the expansion, saying they worry about the long-term cost of Medicaid to the state. But in the short-term at least, the ACA provides 90-100% federal funding for newly-eligible Medicaid recipients.

In Arkansas, where low-income residents can use Medicaid dollars to shop for insurance on its exchange, hospitals report a drop in emergency room visits (2%) and a major decline in uninsured patients (30%), according to Arkansas Hospital Association vice president Jodiane Tritt.

As she told HRI’s Matt DoBias: “That means our emergency rooms are not getting overcrowded, doctors are finally getting paid—particularly in rural Arkansas for seeing patients who now have a payment source they never had before—and the folks that really do need inpatient care are coming to us at the appropriate time, and they have a paying source.”

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  1. don’t you think that its astonishing individuals that say they need to help the less advantaged do as such by expanding their numbers in an appalling project (Medicaid)?

  2. Medicaid Expansion has helped many people and families in need. Many who are unable to work due to disabilities or injuries are now eligible to receive care and get back into the workforce. Now that more people are able to receive the health care they need, more staffing would be needed in the healthcare industry, thus, creating more jobs. Millions of lives were at stake because they were not able to afford the care that they needed. Mothers, fathers, babies and children are just some of many who needed assistance to get the care necessary to save their lives.
    Many women were unable to afford contraceptive to prevent unintended pregnancies and 1 in 3 women have reported they stopped using their birth control because they could not afford it. The “Obamacare” simulation has decreased teen pregnancy by 80%. Since the expansion of medicaid, woman have saved $1.4 billion on birth control spending while unintended pregnancies and abortions cost tax payers $21 billion per year.
    Let’s not forgot the facts stated above in this article. There has been a decrease in ER visits and a reduction of unpaid care. This alone has created $45 million in revenue in 2014. At this time, many are stating that we cannot justify the costs of medicaid expansion, however, it seems like all the numbers are right in front of us to analyze a good healthcare and financial decision.

  3. Perhaps the biggest question of all is why so many in the US feel that, unlike almost all other “advanced” countries, our citizens should be allowed to go without health insurance. We can argue about the merits of doing this by a public, private or hybrid approach, but let’s at least agree that a universal health insurance model is long overdue.

  4. http://www.medscape.com/viewarticle/830104

    Looks like ER use is not down.

    Secondly, while Medicaid parity was in force the last two years, it is not clear that it will continue. This is not a good incentive for enticing practices to see Medicaid patients, many of whom require extensive care and have social issues that complicate medical care to boot.

    • Perry, don’t you find it amazing people that say they want to help the less advantaged do so by increasing their numbers in a terrible program (Medicaid)?

        • In essence that is how the ACA law is handling things. According to the numbers in the future Medicare will paid less and probably be what Medicaid is today. That is how the left treats those the left made dependent upon such a program.

          Will that happen? Already alterations are occurring so it doesn’t, but that is not the way the legislation is written.

          Obama said it on the campaign trail to the daughter of a sick Medicare patient: Paraphrasing ‘your mom doesn’t need the pacemaker she can take a pill and die of complete heart block’.

          • “According to the numbers in the future Medicare will paid less and probably be what Medicaid is today.”

            What numbers?

            “That is how the left treats those the left made dependent upon such a program.”

            Yes, they’d be better off with no coverage at all. Seems the “right” wants to wean seniors off Medicare as well. Your support of vouchers certainly won’t pay more.

          • The ACA was a comprehensive bill passed to save money. All the fiscal problems involved with healthcare were supposedly be managed by the administration and the ACA law. The problem is that if we follow what Obama demanded then Medicare payments continuously fall even below Medicaid rates. These are actuarial numbers that I am surprised you haven’t seen. I am sure much of that money will suddenly appear in Medicare like has already occurred, but that means this administration intentionally lied and so did anyone that promoted Obamacare. This means that the fiscal problems only grow, but who cares, the children and grandchildren will have that debt.

            The left pretends to be doing something to help the poor and needy but their actions are the opposite of their words.

            The right attempts to balance budgets. Balanced budgets are what will save the American economy. If you remember when the Democrats controlled both houses and the Presidency they still didn’t pass a budget mandated by law. I’m not terribly happy with the Republicans either, but I recognize the President is Democrat and the Senate is led by Democrats so the ball is in their court. If the Republicans gain the Senate and keep the house then I will place more blame on their side, but until then one has to blame those in power.

        • “The ACA was a comprehensive bill passed to save money.”

          No, it was passed to get everyone covered, savings (if any) will be far down the road. So far, unless you get a subsidy, the insured will spend more due to broader coverage.

          “These are actuarial numbers that I am surprised you haven’t seen.”

          Link please.

          • I admit it was passed for more than one reason, but the budget was of utmost importance in the decision to pass this bill. The administration stated the ACA would save money and that the healthcare bill would fall.

            It appears most likely that healthcare costs will increase while people are paying more for care and many will have smaller panels. Not a good deal.

            There have been numerous reports and I don’t have the link available at this time so you will have to do the searching. Again I am surprised you haven’t seen these reports.

    • Yes Perry, Medicaid should pay what Medicare pays, that will better protect those at risk patients.

      • Yes, that would help. The bigger question is how to address the innumerable social problems that afflict the poor and result in the conditions which cause or excacerbate many of their medical problems to begin with.

        • @ Perry,

          Well, we can’t solve everything at once. The social structure of at risk populations in possibly high risk neighborhoods probably can’t be solved, but at least they’ll get health care, which means we can continue to pay them minimum wage for dead end jobs that gives us better prices.

          • Or send the jobs to India where they get pennies a day and no health care at all.

          • @ Perry,

            Never seen a service job go to India. It’s hard to order your hamburger via Skype and get it in a reasonable amount of time.

          • Peter1 if you believe the wealth of this country will be maintained by the hamburger flipper then count on the American standard of living falling to third world status.

        • “if you believe the wealth of this country will be maintained by the hamburger flipper then count on the American standard of living falling to third world status.”

          There you go again, misrepresenting my comments and views.

          BTW, in many parts of the country they’re already in 3rd world status, minus the mud huts, thanks to nothing else but hamburger flippers.

          • Peter 1: “There you go again, misrepresenting my comments and views.”

            This what you said Peter1: “Never seen a service job go to India. It’s hard to order your hamburger via Skype”

            Service jobs don’t increase wealth and too many service jobs are the equivalent of hamburger flippers. If you say it I will copy your words and repeat them in argument. How can you complain?

          • @ allan, where did I say I believed wealth is maintained by hamburger flipper wages? You miss the entire crux of the argument in context then extract a sentence which you turn into what I believe.

          • Peter1, I can’t help how you phrase your responses. It is clear to me that what I said accurately reflects your opinion. That you believe it doesn’t means either you changed your mind or your statement was inadequate.

            We have seen this before. Let me correct another item while I am at it.

            You seem to believe that the ACA was passed to do one item, insure more people and that budgetary concerns weren’t an issue. I want to just remind you of what the ACA letters stand for:

            AFFORDABLE Care Act

  5. Cici C.“The law as written would have provided Medicaid coverage …. But a June 2012 Supreme Court ruling made the expansion optional for states, creating a patchwork of coverage”

    It sounds like you are blaming the Supreme Court instead of the lousy work done by legislators that were concerned more for an agenda than the health and well being of the American people.

    “Some governors have resisted the expansion, saying they worry about the long-term cost of Medicaid to the state. But in the short-term at least, the ACA provides 90-100% federal funding for newly-eligible Medicaid recipients.”

    That is absolutely correct. Though you didn’t comment on this I will. It appears that some governors don’t recognize that free money from the feds is really the money their citizens paid in taxes. They also don’t realize the effect on state budgets. Those governors acted in a fiscally irresponsible manner. I’m not arguing about the Medicaid coverage rather the shortsightedness of the governors concerned. They should be looking at ways of controlling budgets not leaving the problem to future generations.

    “ our emergency rooms are not getting overcrowded”

    This is a very questionable comment since it has been reported over and over again that Medicaid patients are one of the highest users of ER care.

  6. nice people nic thinking, if you all help a free cost hospital could help poor peoples and reduce child death rate. join us as other people: https://www.facebook.com/internationalmedicalaid
    Basic healthcare is a universal human right, yet millions of individuals around the world lack access to even elemental medical and wellness services. International Medical Aid is a broad-based non-profit organization striving to improve access to medical and public health resources in the world’s most impoverished areas through fully staffed and strategically deployed mobile healthcare campaigns. Built on values of integrity, mutual respect and commitment to the communities we serve, International Medical Aid is pioneering the new standard for medical non-profits around the world.

  7. Nice piece of cheerleading for for-profit hospitals. Those darned investor-owned hospitals, they’re such good guys. The sample here, 538, accounts for about half investor owned, for-profit hospitals in the US, according to the American Hospital Association. This category of hospitals accounts for 18% of all US hospitals. So, these hospitals account for a minority of admits to US hospitals,

    Just like wellness vendors and other magicians advancing an agenda, all we get here is babbling about relative data: LifePoint reduced its financial exposure to poor and needy patients by 30%! Wow! But, it’s meritorious only if we know 30% of what? How much charity care do for-profit hospitals provide? In comparison to their tax-exempt peers? What proportion of their admits are Medicaid? For an entity that is part of an accounting company, it seems an odd aversion to numbers.

    Knowing that the poor can now more easily get care is only half the issue. Is the care appropriate? What are the outcomes of getting all this wonderful care? Mortality? Morbidity? Return to work? Are all these poor people being screened for things that they don’t have that Medicaid will pay for?

    The ACA is a full employment act for the hospital industry, much to the detriment of the American population, as it goes on the hunt for healthy and unaccosted.

  8. OMG!!!

    I feel so foolish for EVER opposing the our government’s plan for spending over a trillion dollars to give a small percentage of our population totally free healthcare.

    I can see now that the ACA is most brilliant, effective, and revolutionary change in healthcare since the invention of penicillin. According to Ms. Connolly, ER’s are no longer crowded, hospitals are flush with newfound cash (courtesy of my federal tax $$, no less) and you can’t find an uninsured person anywhere who feels even like they might have a sore throat, much less need admission to the hospital.

    And ALL THAT just within the last 6-12 months!!! wow!!! Hospitals that are just now getting around to reporting to the CDC their admissions data and outpatient data for 2012, have got up to the minute reports of decreased ER utilization, “46% reductions in charity care,” not to mention free candy, pretty nurses, clean sheets, and blanket warmers.

    And all we had to do is give away free healthcare??? Boy do I feel stupid.

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