Medicaid Expansion Brings Improvements to Expansion States
States that expanded their Medicaid programs under the Affordable Care Act have experienced fewer hospital admissions, shorter lengths of stays in the hospital, and lower hospital costs, according to a new Health Affairs study.
Specifically, they experienced:
- a 3.1 percent decline in inpatient days
- a 3.5 percent decrease in discharges for conditions considered “ambulatory care-sensitive,” such as diabetes, chronic respiratory problems, and pneumonia
- a reduction of nearly three percent in hospital costs.
Pennsylvania is one of those expansion states, and Medicaid expansion has greatly enhanced the ability of Pennsylvania safety-net hospitals to serve their communities.
Learn more about how Medicaid expansion has improved the health of the population in states that expanded their Medicaid programs in the Health Affairs study “Medicaid Expansion Associated With Reductions in Preventable Hospitalizations.”
The Medicaid DSH cut was included in the 2010 health care reform law in anticipation of a great reduction in the number of uninsured people leaving hospitals providing much less uncompensated care and therefore not in need of as much DSH money. The law’s reach has not proven to be as great as anticipated, however, and two developments since the law’s passage have put a damper on the expected rise in the number of insured Americans: a court decision that made it optional for states to expand their Medicaid program and the repeal of the requirement that everyone purchase health insurance.
As reported by Kaiser Health News,
The Philadelphia Business Journal reports that since Hahnemann’s closing was announced during the summer, ER volume has risen 15 percent, admissions have risen 12 percent, and births have risen more than 50 percent at Thomas Jefferson University Hospital, a SNAP member. Meanwhile, SNAP member Pennsylvania Hospital has seen its ER visits rise nine percent, SNAP member Penn Presbyterian Medical Center has seen its ER volume increase five percent, and SNAP member the Hospital of the University of Pennsylvania has seen its ER volume rise five percent.
This area is served almost exclusively by Pennsylvania safety-net hospitals and recently suffered a major loss when one of those providers, Hahnemann University Hospital, closed its doors. 
Pennsylvania rates will rise an average of four percent for individual plans and 9.7 percent for small groups, the state Insurance Department has announced. All insurers that offered plans in 2019 will do so again in 2020 and the exchange will include a new insurer and increased choice in some of the state’s 67 counties. Beginning in 2020, residents of only six counties will have only a single insurer offering individual plans.
The Department of Human Services bulletin outlines the purpose of the new PDL, provides background information, and describes how the PDL was developed and will work. In addition, it lists the past Medical Assistance Bulletins rendered obsolete by the new bulletin and describes the prior authorization procedures that will be employed when the new program takes effect on January 1, 2020.
Included in this month’s edition are articles about:
Earlier this year, the Department of Human Services announced its intention to implement a preferred drug list in the state’s Medicaid program. That PDL would apply to both the fee for service and managed care Medicaid programs.
Today, Lyft is working with approximately 35 state Medicaid programs while Uber, at least so far, participates only in Arizona’s program.