ASPE Issue Brief Page 6
ASPE Office of Health Policy
Medicaid Expansion and Hospital Care
A particular point of financial vulnerability for women is the cost of hospital care, which is often
expensive and may not be planned. In states that expanded Medicaid under the Affordable Care Act,
women were less likely to be left uninsured during a hospitalization than in states that did not expand
Medicaid.
The proportion of inpatient hospital discharges attributable to uninsured women in states that
expanded Medicaid dropped by 3.3 percentage points from 7.1 percent in 2010 to 3.8 percent in 2014; in
contrast, in non-expansion states, the proportion of inpatient discharges attributable to uninsured women
decreased by only 1.7 percentage points from 8.0 percent to 6.3 percent.
Put another way, the number
of uninsured hospitalizations in Medicaid expansion states decreased by 50.5 percent (from 381,776 in
2010 to 188,798 in 2014), while the number of uninsured hospitalizations in non-expansion states
decreased by only 4.0 percent (from 415,438 in 2010 to 398,745 in 2014).
This coverage trend
demonstrates the financial protections created by the Affordable Care Act, and Medicaid expansion in
particular, and helps explain why hospitals in Medicaid expansion states also have more significant
reductions in uncompensated care since passage of the Affordable Care Act than hospitals in non-
expansion states.
Medicare Prescription Drugs
Prior to the Affordable Care Act, Medicare Part D beneficiaries experienced a coverage gap in their
prescription drug coverage, termed the “donut hole”. The Affordable Care Act closes the donut hole
over several years until it is completely closed in 2020. Since this Affordable Care Act provision went
into effect in 2010 through 2015, beneficiaries with Medicare prescription drug coverage have saved
more than $20 billion on prescription drugs -- including savings of $11 billion for the more than 6
million women with Medicare Part D.
Concurrently, women with Medicare Part D note an
improvement in affordability, with a 3.8 percentage point decline in the proportion of women saying
they could not afford prescription medication in the past 12 months (Table 2).
Hu, L, Kaestner, R, Mazumder, B, Miller, S, Wong, A. “The Effect of the Patient Protection and Affordable Care Act
Medicaid Expansions on Financial Well-Being,” National Bureau of Economic Research, Working Paper 22170, April 2016.
http://www.nber.org/papers/w22170.
AHRQ analysis of 2010 and 2014 Healthcare Cost and Utilization Project (HCUP), State Inpatient Databases (SID) data.
For this analysis, Expansion States include AR, AZ, CA, CO, CT, HI, IA, IL, KY, MD, MI, MN, NJ, NM, NV, NY, OH, OR,
RI, VT, WA, WV (n=22); Nonexpansion States include FL, GA, IN, KS, LA, MO, MT, NC, NE, OK, PA, SC, SD, TN, TX,
VA, WI, WY (n=18). Four States (IN, LA, MT, PA) that expanded their Medicaid programs in 2015 or 2016, are considered
as Nonexpansion States for this analysis.
Agency for Healthcare Research and Quality (AHRQ) analysis of Healthcare Cost and Utilization Project (HCUP), State
Inpatient Databases (SID), 2010 and 2014.
HHS, Office of the Assistant Secretary for Planning and Evaluation, 2015. ASPE Issue Brief: Insurance Expansion,
Hospital Uncompensated Care, and the Affordable Care Act. https://aspe.hhs.gov/pdf-report/insurance-expansion-hospital-
uncompensated-care-and-affordable-care-act
ASPE estimated the number of women who had Medicare Part D savings during 2010-2015 based on CMS’s estimated
total number of beneficiaries with Part D savings (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-
releases/2016-Press-releases-items/2016-02-08.html) and the ratio of female to total non-Low Income Subsidy beneficiaries
generated from Medicare Prescription Drug Event (PDE) data.
This trend is statistically significant (p-value<0.001).