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Study finds decrease in uninsured hospital patients, increase in those with Medicaid

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In a study appearing in the June 21 issue of JAMA, Matthew M. Davis, M.D., M.A.P.P., of the University of Michigan, Ann Arbor, and colleagues examined changes in insurance coverage among hospitalized nonelderly adults after Michigan expanded Medicaid coverage in 2014 under the Affordable Care Act (ACA).

Using the Michigan Inpatient Database, the researchers compared insurance coverage for hospitalized patients during initial implementation of the Healthy Michigan Plan in April-December 2014 with corresponding months in 2012 and 2013 and examined patterns at the level of individual hospitals to ascertain whether the consequences of expanded coverage were uniform across institutions.

The analysis included 130 hospitals in Michigan that provide acute care. In April-December, uninsured patients represented 5.8 percent in 2012 and 6 percent in 2013 of nonelderly adult discharges compared with 2 percent in 2014. The proportion of discharges for nonelderly adults with Medicaid increased from 23 percent in 2012 and 24 percent in 2013 to 30 percent in 2014. The changes in proportions of discharges with private coverage and Medicare over the same period were smaller. Most of the changes in the proportions of uninsured and Medicaid discharges occurred in the first quarter of Medicaid expansion and remained stable for the rest of 2014.

In 94 percent of Michigan's acute care hospitals, the proportion of discharges for uninsured patients was lower in 2014 compared with the average proportion of uninsured discharges for 2012 and 2013. Conversely, in 88 percent of those hospitals, the proportion of discharges for Medicaid patients in 2014 exceeded the average proportion of discharges with Medicaid for 2012 and 2013.

"The reductions in uninsured patients occurred without an increase in the number of hospitalized nonelderly adults, suggesting opportunities to reduce uncompensated care," the authors write.

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(doi:10.1001/jama.2016.6303; the study is available pre-embargo to the media at the For the Media website)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Kara Gavin
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