The Affordable Care Act and Medicaid expansion that took hold in participating states was a crucial boost to hospitals that treat a high volume of gunshot victims, says a new study from the Urban Institute. The analysis indicates that a contraction of coverage, especially for low-income adults, would put victims and the hospitals treating them at greater risk for bearing the costs of armed assault.
If Kentucky's payer mix, for example, returns to 2010 pre-ACA levels, more than 50 percent of the state's armed assault victims with emergency room or hospital stays would be uninsured. That state was an early adopter of Medicaid expansion, and from 2010 to 2014, its uncompensated care for gun victims dropped from 54 percent to 13 percent, with Medicaid accounting for 68 percent of the coverage.
In addition to Kentucky, the study examined Arizona, Florida, New Jersey, North Carolina and Wisconsin. The average hospital cost per patient was high, ranging from $9,000 to $18,000. While the states that opted out of expansion saw little change to their payer mix, those who were on board saw Medicaid pick up a larger portion of the costs associated with gun violence.
In Florida, not much changed from 2010 to 2014 in terms of payment or payer mix, as that state declined to expand Medicaid. The situation in Wisconsin was unique. In 2010, the state's Medicaid program covered single adults earning up to 200 percent of the federal poverty level through a Section 1115 waiver. But the state capped the program by not allowing new individuals to enroll. It then used funds to expand its program to cover all adults with incomes up to 100 percent of the poverty level, and the result was a dip in hospital costs that were uncompensated -- from 24 percent in 2010 to 11 percent by 2014 -- and an increased share of costs paid by public coverage, going from 55 percent in 2010 to 67 percent by 2014.
Ultimately, the study found that hospitals might raise rates to cover higher levels of uncompensated care if Medicaid is reduced.