Hospitals appear to be benefiting from reductions in the number of uninsured patients as a result of the Affordable Care Act.
Two reports issued last week offer some much-needed information on the progress of the ACA, but more data are needed, according to the authors of the reports.
A New England Journal of Medicine report written by Commonwealth Fund officials lays out the number of people who gained insurance under the ACA since Oct. 1. Meanwhile, a credit analysis by Fitch Ratings found that the Medicaid expansion is resulting in favorable upticks in coverage for people previously uninsured, at least for the for-profit companies it follows. A third report, issued by the White House, was also positive, but you have to consider the potential political undertones.
The NEJM analysis drew some attention, and rightly so, because of the large number it reported had gained insurance: 20 million. Broken down, an estimated 8 million people enrolled through a public insurance exchange, 6 million gained coverage through expansion of Medicaid or the Children's Health Insurance Program, 5 million purchased directly from an insurer and 1 million gained coverage through a parent's policy.
The authors — David Blumenthal, M.D., president of the Commonwealth Fund, and Sarah Collins, vice president, health care coverage and access — noted that the information is useful, given how little is known about the effects of the ACA at this early stage, but still a lot is unknown.
"Ultimately, the success of the coverage expansions of the law will be judged by their effect on a set of variables: the numbers of uninsured Americans, the adequacy of insurance (which will perhaps best be judged by the number of people who remain underinsured), and the affordability of private coverage," they wrote. "It may take years, however, before we can render a considered judgment on these critical outcomes."
Another early indicator of the ACA can be found in the Fitch report. From a corporate credit perspective, the early signs for the first quarter show that the uninsured number was down as a result of Medicaid expansion, with late-joining states giving that number some extra oomph.
Tempering Fitch's enthusiasm was a continued slowdown in volume, with same-hospital admissions falling 3.6 percent and adjusted admissions falling 1.4 percent.
Like the Commonwealth Fund authors, Fitch's analysts don't have a grip on the whole picture yet. "To view the effect of changes in uncompensated care on net revenue growth and margins, it is best to take a holistic view of uncompensated care, including bad debt expense, charity care and discounts, and to place the emphasis on trend over time rather than quarter-to-quarter fluctuations," they wrote.
Unfortunately, it is likely to take some time before that holistic view becomes available, so bits and pieces of data will have to do until then.