The Effect of Public Health Insurance on the Hospital Industry (2014)

Principal Investigator: Tal Gross, PhD, Columbia University

This project aims to inform policy-makers about strategies for regulating hospitals following health reform by studying how a reduction in the uninsured affects hospital uncompensated care. The researchers will first complete a descriptive analysis that measures the associations between the size of a state's uninsured population, the share of state residents that are foreign born, the state's unemployment rate, and the uncompensated care provided by the state's hospitals. The researchers will then explore two large Medicaid disenrollments in Tennessee and Missouri--policy changes that were like the ACA's Medicaid expansion in reverse. The researchers will use a difference-in-differences approach to isolate the effect of the Medicaid disenrollments on hospitals' uncompensated care costs in those states. The researchers will quantify the increase in uncompensated care relative to the number of people who lost coverage and compare this number to the descriptive analyses. They will then multiply their estimates by the ACA's predicted change in coverage rates across the country to predict the change in uncompensated care driven by the ACA. 

Publications

Insurance Expansion and Hospital Emergency Department Access: Evidence from the Affordable Care Act
(February 2017, Annals of Internal Medicine)

Why Medicaid Expansion Makes Economic Sense
(July 2015, Video)

Hospitals as Insurers of Last Resort
(June 2015, National Bureau of Economic Research)