Affordable Care Act’s Medicaid Expansion Benefits Hospitals, Particularly in Rural America
End Notes
[1] We thank Fredric Blavin, Senior Research Associate at the Urban Institute, for his assistance in providing data for this analysis.
[2] Frederic Blavin, “How Has the ACA Changed Finances for Different Types of Hospitals? Updated Insights from 2015 Cost Report Data,” Urban Institute, April 2017, http://www.urban.org/sites/default/files/publication/89446/2001215-how-has-the-aca-changed-finances-for-different-types-of-hospitals.pdf.
[3] Rural hospitals are defined as those in non-metropolitan counties as designated by the Office of Management and Budget. Non-metropolitan counties include micropolitan statistical areas and noncore areas, open countryside, rural towns (with populations below 2,500), and areas with populations of 2,500 to 49,999 that are not part of larger metropolitan area labor markets.
[4] Analysis of unpublished data from the Urban Institute’s April 2017 analysis. Both published and unpublished results are based on data from the American Hospital Association annual survey for non-federal general or surgical hospitals merged with data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System. All data are for 2011 through 2015, with comparisons made between the 2011-2013 and 2014-2015 periods. Medicaid expansion states are the 19 states that implemented the expansion to low-income adults as of January 1, 2014. The Urban analysis compares results in expansion states to those in non-expansion states, controlling for hospital characteristics including organizational status, system status, hospital size, metro/non-metro designation, provision of burn services, provision of chemical dependency services, and county unemployment rate.
[5] Jesse Cross-Call et al., “House-Passed Bill Would Devastate Health Care in Rural America,” Center on Budget and Policy Priorities, May 16, 2016, https://www.cbpp.org/research/health/house-passed-bill-would-devastate-health-care-in-rural-america.
[6] Julia Foutz, Samantha Artiga, and Rachel Garfield, “The Role of Medicaid in Rural America,” Kaiser Family Foundation, April 25, 2017, http://kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america.
[7] Michael Karpman et al., “Substantial Gains in Health Insurance Coverage Occurring for Adults in Both Rural and Urban Areas,” Urban Institute, April 16, 2015, http://hrms.urban.org/quicktakes/Substantial-Gains-in-Health-Insurance-Coverage-Occurring-for-Adults-in-Both-Rural-and-Urban-Areas.html.
[8] Craig Garthwaite, Tal Gross, and Matthew Notowidigdo, “Hospitals as Insurers of Last Resort,” National Bureau of Economic Research, NBER Working Paper No. 21290, June 2015, http://www.nber.org/papers/w21290.pdf.
[9] A hospital’s operating margin is a good measure of how much it earns providing care to patients. A hospital’s excess margin is good measure of its bottom line.
[10] Jesse Cross-Call, “House-Passed Bill Would Undermine Medicaid’s Critical Role in Rural America,” Center on Budget and Policy Priorities, June 7, 2017, https://www.cbpp.org/blog/house-passed-bill-would-undermine-medicaids-critical-role-in-rural-america.
[11] Center on Budget and Policy Priorities, “Tracking Reports About the Emerging Senate Bill to Repeal the Affordable Care Act,” June 22, 2017, https://www.cbpp.org/research/health/tracking-reports-about-the-emerging-senate-bill-to-repeal-the-affordable-care-act.
[12] For more information on the House bill’s impact on the Medicaid expansion population, see Matt Broaddus and Edwin Park, “House Republican Health Bill Would Effectively End ACA Medicaid Expansion,” Center on Budget and Policy Priorities, June 2017, https://www.cbpp.org/sites/default/files/atoms/files/6-6-17health.pdf.