06 Aug Texas A&M Studies Effect of Affordable Care Act on Uninsured Hospitalizations
MedicalResearch.com Interview with:
Dr. Ukert
Benjamin Ukert PhD
Assistant Professor
Department of Health Policy and Management
Texas A&M University, School of Public Health
Texas 77843-1266
MedicalResearch.com: What is the background for this study?
Response: The Affordable Care Act (ACA) was enacted in March 2010 with one major goal to increase access to insurance coverage. This was done through the expansion of the Medicaid program for low income individuals and the establishment of formal health insurance marketplaces for individuals without access to employer sponsored insurance. Texas did not expand Medicaid for low income individuals, but the health insurance marketplace should have led to increases in insurance coverage, due to generous federal subsidies that cover a large share of the health insurance premium.
Gaining insurance coverage can affect providers, such as hospitals, who treat a large share of uninsured individuals. We focused on the inpatient setting and evaluated whether the ACA led to changes in demand for hospital care, and whether the ACA led to reduction in the share of uninsured individuals treated by hospitals.
MedicalResearch.com: What are the main findings?
Response: We found that the hospital inpatient uninsured discharge rate decreased by about 10 percent for the average hospital, but did not find any changes in hospital volume, suggesting that the demand for hospital care didn’t change.
MedicalResearch.com: What should readers take away from your report?
Response: The study exclusively focused on the private market because the ACA marketplace expanded coverage for people with private insurance. No changes in public (Medicaid) insurance coverage was measured (as expected) because there was no change in Medicaid eligibility during this time in Texas.
MedicalResearch.com: What recommendations do you have for future research as a results of this study?
Response: We only focused on the inpatient setting where patients receive care for elective care and serious medical conditions. It would be worthwhile to understand if the findings generalize in the outpatient setting. Changes in insurance mix, namely from uninsured to insured, have also financial consequences for hospitals. Ideally, hospitals have lower bad debt and charity care, as more patients with coverage are treated. This would also mean that hospitals’ financial situation should be improved that could lead to additional staffing and infrastructure improvements. However, there is relatively little evidence displaying how this policy may have affected the operation of hospitals.
MedicalResearch.com: Is there anything else you would like to add? Any disclosures?
Response: Notably, the policy improved access to hospital care for in counties with a larger population of Black patients, in counties with a significant share of women and in urban counties. Moreover, the reductions in uninsured were generally concentrated in common high volume diagnoses, such as deliveries.
Citation: Khodakarami N, Ukert B. Effects of Affordable Care Act on uninsured hospitalization: Evidence from Texas. Health Serv Res. 2024; 59(4):e14334. doi:10.1111/1475-6773.14334
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Last Updated on August 6, 2024 by Marie Benz MD FAAD