Strategic Planning & Timelines

Safety net hospitals rely on disproportionate-share hospital (DSH) payments to help cover uncompensated care costs and underpayments by Medicaid. The ACA anticipates that insurance expansion will increase safety net hospitals’ revenues and will reduce DSH payments accordingly. This study examines the impact of the ACA’s Medicaid DSH reductions on California public hospitals’ financial stability by estimating how total DSH costs (uncompensated care costs and Medicaid shortfalls) will change as a result of insurance expansion and the offsetting DSH reductions. The researchers found that decreases in uncompensated care costs resulting from the ACA insurance expansion may not match the DSH reductions because of the high number of people who will remain uninsured, low Medicaid reimbursement rates, and medical cost inflation.
 

Using the 2014 health insurance exchange enrollment data and a micro-simulation model funded in part by the U.S. Department of Health and Human Services, this working paper estimates the national and state impact of the ACA on insurance prices and enrollment from 2015-2024. Estimating the trajectory of health plan prices and enrollment is critical to informing ongoing health care policy debate. Decisions regarding the delayed implementation of the qualified health plan requirements, the delayed enforcement of the employer mandate, and the scheduled termination of the temporary reinsurance and risk corridor programs are estimated to have dramatic impact on insurance prices and enrollment by 2017.
 

With the enactment of the ACA, millions of previously uninsured individuals will gain insurance coverage through either Medicaid or private plans purchased through the health care marketplaces.  As people gain coverage, providers’ costs associated with caring for uninsured individuals that previously went uncompensated will decline, as more people have a direct source of payment (insurance) for their care.  This report examines uncompensated care in 2013, just before implementation of health reform’s major coverage provisions. These estimates provide an important baseline against which to measure major changes that are occurring under the ACA.
 

The ACA has the potential to dramatically improve rates of health insurance coverage for low-income Americans, including many vulnerable populations. This fact sheet highlights particularly vulnerable populations that could benefit from insurance coverage, but may have trouble getting access, including: (1) racial and ethnic minority populations; (2) homeless individuals; (3) the jail-involved population; and (4) veterans.  The fact sheet outlines opportunities to connect these individuals to coverage with an eye toward the next open enrollment period.
 

This is the ninth issue brief in a series released by Hilltop's Hospital Community Benefit Program. This brief continues the program's examination of state-level community benefit oversight by examining the current hospital-reported programs and initiatives that target specific social and economic factors in ten states. It also identifies standard regulatory tools and characteristics of implementation strategies used by those states that could facilitate hospital investment in activities that address social and economic determinants.