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Infographic showing result of decision by states to refuse Medicaid expansion money.

Last week we got a hint from some hospital companies operating in multiple states that they were seeing something very real happen after the first enrollment period for Obamacare—fewer uninsured people seeking care. The Washington Post's Jason Millman follows up on that report, reviewing the last few weeks of earnings calls for publicly traded hospitals and comes to a clear conclusion: "They're reporting a blue state-red state divide in the kinds of patients they're seeing."
The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.

Community Health Systems, with facilities in 29 states, also noticed an expansion gap. In expansion states it serves, CHS said it saw self-pay admissions drop 28 percent while Medicaid admissions increased by 4 percent. Self-pay emergency room visits decreased 16 percent in expansion states, but they increased in non-expansion states, the company said in its earnings call last week.

Tenet Healthcare reported last week that it had a 17 percent increase in Medicaid inpatient visits while uninsured visits decreased 33 percent in the four expansion states where it operates. In non-expansion states, Medicaid admissions dropped 1 percent as uninsured care rose 2 percent. Tenet also said it's seeing that emergency room visits are continuing to rise.

That's good news for these hospitals' bottom line, and why so many hospitals have lobbied state governments hard for Medicaid expansion—Medicaid reimbursements are certainly preferable to no reimbursements at all. That 30 percent drop in uninsured patients is pretty huge. That's not just saving the hospitals money, it's saving the states money. The states end up paying for a lot of uncompensated care hospitals provide, so reducing the numbers of those uninsured patients makes a lot of fiscal sense.

But fiscal sense—and the moral imperative of saving tens of thousands of lives—means bupkis to Republicans who hate Obamacare.

Originally posted to Joan McCarter on Mon May 12, 2014 at 05:09 PM PDT.

Also republished by Obamacare Saves Lives and Daily Kos.

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Comment Preferences

  •  Tip Jar (25+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Mon May 12, 2014 at 05:09:11 PM PDT

  •  This: (5+ / 0-)
    it's saving the states money. The states end up paying for a lot of uncompensated care hospitals provide, so reducing the numbers of those uninsured patients makes a lot of fiscal sense.
    How much is it saving?
    More to the point, how much is it costing people in non-expansion states that their Governors/Leges are screwing them?

    If I ran this circus, things would be DIFFERENT!

    by CwV on Mon May 12, 2014 at 05:20:10 PM PDT

    •  Maybe they'd rather be right and poor. . . . (4+ / 0-)
      Recommended by:
      True North, CwV, alypsee1, Sylv

      Actually I can imagine making some moral choices even if they cost more (example: buying Fair Trade coffee and chocolate). So the money-saving argument doesn't necessarily trump everything.

      But in this case, the moral argument for refusing to allow people to have health care is just awful. And the states aren't basing their decisions on that; they're claiming that the expansion would cost too much. They lie.

      •  "Right" isn't even the issue. (5+ / 0-)

        My lovely Gov, Bentley of AL, rejected Medicaid expansion because it was an unfunded program at the Federal level, or some such nonsense. Meanwhile, when we had a bunch of tornadoes hit the state 2 weeks ago, he pronounced that he was going to work to get every Federal dollar he could get to help.  And of course, AL is a net recipient of federal taxes (all those defense dollars in the TN Valley, for one.) It doesn't make a lick of sense: if Federal deficit  spending is bad, then Federal deficit spending is bad, no matter what it's spent on.  But not in his pea brain.  

        Oh, and the kicker: Bentley is a physician.  So much for "first, do no harm."

        Republicans: If they only had a heart.

        by leu2500 on Mon May 12, 2014 at 07:00:12 PM PDT

        [ Parent ]

  •  I made a Dr. appointment today..... (9+ / 0-)

    ...and they asked what insurance I had and I said Premera.

    And that's the first time I have ever said that in my adult life. I've always said I didn't have insurance.

    And I like that. :-)

    O great creator of being grant us one more hour to perform our art and perfect our lives. ::: Jim Morrison :::

    by Kevanlove on Mon May 12, 2014 at 05:44:13 PM PDT

  •  a tweet earlier in the day....summarizes it well (3+ / 0-)
    Recommended by:
    blueyedace2, OldDragon, keyscritter
  •  It comes down to this: (2+ / 0-)
    Recommended by:
    keyscritter, jfdunphy

    The Republican Party:  The Party of Death.

    There's the bumper sticker.

    ======================================================== Those who can, teach. Those who can't teach, make rules about teaching.

    by oxfdblue on Tue May 13, 2014 at 07:18:44 PM PDT

  •  When the hospitals don't have to pass (2+ / 0-)
    Recommended by:
    keyscritter, jfdunphy

    along the cost of uninsured people in the form of higher fees for services to those who CAN pay, that means the insurance premiums for the rest of us who do have health insurance will not rise as much.

    These are the "cost controls" so many people didn't understand were part of ACA.

  •  They. Don't. Care. About. Poor. People. (1+ / 0-)
    Recommended by:

    "Mr. President, I'm not saying we wouldn't get our hair mussed. But I do say no more than ten to twenty million killed, tops." General Buck Turgidson

    by muledriver on Tue May 13, 2014 at 08:42:26 PM PDT

  •  It is not only those who turn down Medicaid (0+ / 0-)

    expansion completely. In indiana, Gov. Mike Pence is scheduled to announce some crippled form of Medicaid expansion on Thursday at 10 AM Eastern Time, at Purdue University.

    Gov. Pence to announce expanded Healthy Indiana Plan

    He has been trying to get HHS to agree to let Indiana ding the poor $1100 each for their care, and to provide totally useless Health Savings Accounts and high-deductible private insurance. We do not yet know what HHS agreed to.

    Several other states have waivers to use Medicaid expansion funds to purchase private insurance for the poor, and to impose various other restrictions.

    Back off, man. I'm a logician.—GOPBusters™

    by Mokurai on Tue May 13, 2014 at 09:01:53 PM PDT

  •  At some point during medical school, I (and most (1+ / 0-)
    Recommended by:

    of my classmates) learned that Medicaid keeps hospitals from going bankrupt.  Since then, every time I'm in a conversation where someone is complaining about "freeloaders" or "people who refuse to work" getting free medical care, I would shut them down by saying, "Medicaid keeps the hospital doors open so it will be there when YOU have an emergency."

    I know there have already been hospital closures, mostly in rural areas.  Eventually, urban and suburban hospitals and clinics will be affected, too.  I only hope these 24 states expand Medicaid before their citizens' health is threatened by a critical lack of available facilities.

    •  Important political point, this impacts the rich (1+ / 0-)
      Recommended by:

      If hospitals in states that don't expand medicaid are on much weaker financial footings the rich and the middle class will suffer when they get sick.  If this continues there may be more than 17,000 deaths and some of those will be the kind of folks Republicans call "job-creators", which may just be a different words for political donors.

  •  That's huge (1+ / 0-)
    Recommended by:

    actually, because it really is the writing on the wall for these red state holdouts. Combined with the down trending cost curve in blue states, improved outcomes, better preventive care, hospitals and insurance companies will eventually throw their vast might behind this and squash the holdouts.

  •  It will also be important to note (0+ / 0-)

    that the instances of Medicare and Medicaid FRAUD will likely decline in the Blue states that adopted the Affordable Health Care Act (ACA) reforms. One of the more ubiquitous forms of fraud was "upcoding," meaning that the company might provide a lower level service, but bill for a higher, closely related service. So a 20 minute office visit might be billed as a longer visit, an ambulance ride without oxygen might have been billed as with oxygen, a patient might have been given supplies that they really didn't need, and have to be discarded within a certain time period, and reordered, all of which drives up the revenue stream but adds little to quality of patient care. I believe it would be very instructive to look at Medicare and Medicaid Fraud cases over the next few years, and see what the statistics really tell us. IMO, the Blue states will show much reduced rates of fraud, which translates into savings for the entire system. IMO, it would be a fruitful campaign issue for Democrats running in Red States to take a hard look at medical fraud issues in their states, as that is something that even low-information voters understand hurts them.

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