What Does the Recent Literature Say About Medicaid Expansion?: Economic Impacts on Providers
Issue Brief
Diana Hamer et al., "Effect of Medicaid Expansion on Visit Composition in a Louisiana Health Care System," Ochsner Journal 22 no. 2 (June 2022): 154-162, https://doi.org/10.31486/toj.21.0106
Fan Zhao and Roch A. Niango, "Medicaid Expansion’s Impact on Emergency Department Use by State and Payer," Health Policy Analysis 25 no. 4 (April 2022), https://doi.org/10.1016/j.jval.2021.09.014
Jayani Jayawardhana, "Impact of Medicaid Expansion on Mental Health and Substance Use Related Emergency Department Visits," Substance Abuse 43 no. 1 (July 2021): 356-363, https://doi.org/10.1080/08897077.2021.1941521
Vashisht V. Madabhushi, "Impact of the Affordable Care Act Medicaid Expansion on Reimbursement in Emergency General Surgery," Journal of Gastrointestinal Surgery 26 (May 2021): 191-196, https://doi.org/10.1007/s11605-021-05028-8
Ankit Mishra et al., "ACA Medicaid Expansion Reduced Disparities in Use of High-volume Hospitals for Pancreatic Surgery," Pancreas Presented at the Academic Surgical Congress 2020 170 no. 6 (December 2021): 1785-1793, https://doi.org/10.1016/j.surg.2021.05.033
Benjamin B. Albright et al., "Medicaid Expansion Reduced Uninsured Surgical Hospitalizations And Associated Catastrophic Financial Burden," Health Affairs 40 no. 8 (August 2021), https://doi.org/10.1377/hlthaff.2020.02496
Ashley Lall et al., "Analysis of Emergency Department Utilization in Medicaid Expansion and Non-expansion States," Cureus 13 no. 10 (October 2021), https://doi.org/10.7759/cureus.18561
Blake T. McGee et al., "Associations of Medicaid Expansion With Access to Care, Severity, and Outcomes for Acute Ischemic Stroke," Circulation: Cardiovascular Quality and Outcomes 14 no. 10 (October 2021), https://doi.org/10.1161/CIRCOUTCOMES.121.007940
Theodoros V. Giannouchous et al., "The Effect of the Medicaid Expansion on Frequent Emergency Department Use in New York," Administration of Emergency Medicine 61 no. 6 (September 2021): 749-762, https://doi.org/10.1016/j.jemermed.2021.07.003
Michael K. Dalton et al., "The Impact of the Affordable Care Act’s Medicaid Expansion on Patients Admitted for Burns: An Analysis of National Data," Burns 48 no. 6 (September 2022): 1340-1346, https://doi.org/10.1016/j.burns.2021.10.018
Gianna Dingillo, Christine E. Alvarado, and Christopher W. Towe, "Affordable Care Act Medicaid Expansion is Associated With Increased Utilization of Minimally Invasive Lung Resection for Early Stage Lung Cancer," The American Surgeon (November 2022), https://journals.sagepub.com/doi/10.1177/00031348221138081
Each of the studies that found no impact studied providers that saw very small numbers of uninsured patients in both time periods.
Nina Mulia, Camiillia K. Lui, Kara M. K. Bensley, and Meenakshi S. Subbaraman, "Effects of Medicaid Expansion on Alcohol and Opioid Treatment Admissions in U.S. Racial/Ethnic groups," Drug and Alcohol Dependence 231 no. 1 (February 2022), https://doi.org/10.1016/j.drugalcdep.2021.109242
Jacques A. Greenberg et al., "Association of the Affordable Care Act With Access to Highest-Volume Centers for Patients with Thyroid Cancer," Surgery 171 no. 1 (September 2021): 132-139, https://doi.org/10.1016/j.surg.2021.04.059
Jacob K. Greenberg, Derek S. Brown, Margaret A. Olsen, and Wilson Z. Ray, "Association of Medicaid Expansion Under the Affordable Care Act with Access to Elective Spine Surgical Care," Journal of Neurosurgery Epub ahead of print (September 2021), https://doi.org/10.3171/2021.3.SPINE2122
Hannah T. Neprash, Anna Zink, Bethany Sheridian, and Katherine Hempsted, "The Effect of Medicaid Expansion on Medicaid Participation, Payer Mix, and Labor Supply in Primary Care," Journal of Health Economics 80 (December 2021), https://doi.org/10.1016/j.jhealeco.2021.102541
Gianna Dingillo, Christine E. Alvarado, and Christopher W. Towe, "Affordable Care Act Medicaid Expansion is Associated With Increased Utilization of Minimally Invasive Lung Resection for Early Stage Lung Cancer," The American Surgeon (November 2022), https://journals.sagepub.com/doi/10.1177/00031348221138081
Taitane Santos, Simone Singh, and Gary J. Young, "Medicaid Expansion and Not-For-Profit Hospitals’ Financial Status: National and State-Level Estimates Using IRS and CMS Data, 2011-2016," Sage Journals Medical Care Research and Review 79 no. 3 (April 22, 2021): 448-457, https://doi.org/10.1177/10775587211009720
Paula Chattarjee, Rachel M. Werner, and Karen E. Joynt Maddox, "Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals," Health Affairs 40 no. 12 (December 2021), https://doi.org/10.1377/hlthaff.2021.00643
Qian Lou, Ali Moghtaderi, Anne Markus, and Avi Dor, "Financial Impacts of the Medicaid Expansion on Community Health Centers," Health Services Research 57 no. 3 (October 2021): 634-643, https://doi.org/10.1111/1475-6773.13897
However, only one of these studies found that uninsured visits decreased (the other found no change).
Diana Hamer et al., "Effect of Medicaid Expansion on Visit Composition in a Louisiana Health Care System," Ochsner Journal 22 no. 2 (June 2022): 154-162, https://doi.org/10.31486/toj.21.0106
Hannah T. Neprash, Anna Zink, Bethany Sheridian, and Katherine Hempsted, "The Effect of Medicaid Expansion on Medicaid Participation, Payer Mix, and Labor Supply in Primary Care," Journal of Health Economics 80 (December 2021), https://doi.org/10.1016/j.jhealeco.2021.102541
Paula Chattarjee, Rachel M. Werner, and Karen E. Joynt Maddox, "Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals," Health Affairs 40 no. 12 (December 2021), https://doi.org/10.1377/hlthaff.2021.00643
Karen E. Lasser et al., "Changes in Hospitalizations at US Safety-Net Hospitals Following Medicaid Expansion," Jama Network Open Health Policy 4 no. 6 (June 2021), https://doi.org/10.1001/jamanetworkopen.2021.14343
Yanlei Ma, David Armstrong, Gaetano Forte, and Hao Yu, "Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians," Official Journal of the Medical Care Section, American Public Health Association 60 no. 8 (August 2022): 636-644, https://journals.lww.com/lww-medicalcare/Abstract/2022/08000/Effects_of_the_Affordable_Care_Act_Medicaid.13.aspx
Shiyin Jiao, R. Tamara Konetzka, Harold A. Pollack, and Elbert S. Huang, "Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity," Multidisciplinary Journal of Population Health and Health Policy 100 no. 2 (April 2022): 504-524, https://doi.org/10.1111/1468-0009.12560
Taitane Santos, Simone Singh, and Gary J. Young, "Medicaid Expansion and Not-For-Profit Hospitals’ Financial Status: National and State-Level Estimates Using IRS and CMS Data, 2011-2016," Sage Journals Medical Care Research and Review 79 no. 3 (April 22, 2021): 448-457, https://doi.org/10.1177/10775587211009720
Caitlin Carrol, Julia D. Interrante, Jamie R. Daw, and Katy Backes Kozhimannil, "Association Between Medicaid Expansion and Closure of Hospital-Based Obstetric Services," Health Affairs 41 no. 4 (April 2022), https://doi.org/10.1377/hlthaff.2021.01478
Vashisht V. Madabhushi, "Impact of the Affordable Care Act Medicaid Expansion on Reimbursement in Emergency General Surgery," Journal of Gastrointestinal Surgery 26 (May 2021): 191-196, https://doi.org/10.1007/s11605-021-05028-8
Qian Lou, Ali Moghtaderi, Anne Markus, and Avi Dor, "Financial Impacts of the Medicaid Expansion on Community Health Centers," Health Services Research 57 no. 3 (October 2021): 634-643, https://doi.org/10.1111/1475-6773.13897
Julie S. Darnell and Lindsay O'Brien, "Location, Location, Location: The Affordable Care Act's Impact on Free Clinics Depends on What State They're In," Journal of Health Care for the Poor and Underserved 33 no. 2 (May 2022): 887-901, https://doi.org/10.1353/hpu.2022.0070
Paula Chattarjee, Rachel M. Werner, and Karen E. Joynt Maddox, "Medicaid Expansion Alone Not Associated With Improved Finances, Staffing, Or Quality At Critical Access Hospitals," Health Affairs 40 no. 12 (December 2021), https://doi.org/10.1377/hlthaff.2021.00643
Vashisht V. Madabhushi, "Impact of the Affordable Care Act Medicaid Expansion on Reimbursement in Emergency General Surgery," Journal of Gastrointestinal Surgery 26 (May 2021): 191-196, https://doi.org/10.1007/s11605-021-05028-8
Taitane Santos, Simone Singh, and Gary J. Young, "Medicaid Expansion and Not-For-Profit Hospitals’ Financial Status: National and State-Level Estimates Using IRS and CMS Data, 2011-2016," Sage Journals Medical Care Research and Review 79 no. 3 (April 22, 2021): 448-457, https://doi.org/10.1177/10775587211009720
Caitlin Carrol, Julia D. Interrante, Jamie R. Daw, and Katy Backes Kozhimannil, "Association Between Medicaid Expansion and Closure of Hospital-Based Obstetric Services," Health Affairs 41 no. 4 (April 2022), https://doi.org/10.1377/hlthaff.2021.01478
Thus, the authors note that because Medicaid eligibility limits for pregnant individuals were already at or higher than the newly expanded limit for adults, the expansion would likely only improve the financial performance of obstetrics units indirectly (if hospitals used the additional revenue to cross-subsidize obstetric services).
Shiyin Jiao, R. Tamara Konetzka, Harold A. Pollack, and Elbert S. Huang, "Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity," Multidisciplinary Journal of Population Health and Health Policy 100 no. 2 (April 2022): 504-524, https://doi.org/10.1111/1468-0009.12560
Qian Lou, Ali Moghtaderi, Anne Markus, and Avi Dor, "Financial Impacts of the Medicaid Expansion on Community Health Centers," Health Services Research 57 no. 3 (October 2021): 634-643, https://doi.org/10.1111/1475-6773.13897
Yanlei Ma, David Armstrong, Gaetano Forte, and Hao Yu, "Effects of the Affordable Care Act Medicaid Expansion on the Compensation of New Primary Care Physicians," Official Journal of the Medical Care Section, American Public Health Association 60 no. 8 (August 2022): 636-644, https://journals.lww.com/lww-medicalcare/Abstract/2022/08000/Effects_of_the_Affordable_Care_Act_Medicaid.13.aspx
Thus far, Missouri and Oklahoma implemented expansion in July 2021 following successful ballot initiatives the prior summer, and South Dakota plans to implement expansion in July 2023 following a successful ballot initiative in November 2022.