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Health Aff (Millwood) ; 40(1): 82-90, 2021 01.
Article in English | MEDLINE | ID: covidwho-1007108


States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.

COVID-19/epidemiology , Economics, Hospital , Health Services Accessibility/statistics & numerical data , Hospitals , Medicaid , Medically Uninsured , Humans , Medicaid/economics , Medicaid/statistics & numerical data , Patient Protection and Affordable Care Act/legislation & jurisprudence , SARS-CoV-2 , State Government , United States
Health Econ Policy Law ; 16(3): 251-255, 2021 07.
Article in English | MEDLINE | ID: covidwho-899838


Before his incoherent response to the COVID-19 pandemic, the focus of President Trump's health policy agenda was the elimination of the Patient Protection and Affordable Care Act (ACA), which he has called a 'disaster'. The attacks on the ACA included proposals to repeal the law through the legislative process, to erode it through a series of executive actions, and to ask the courts to declare it unconstitutional. Despite these ongoing challenges, the ACA remains largely intact as the U.S. heads into the 2020 election. The longer term fate of the law, however, is uncertain and the outcome of the 2020 election is likely to have a dramatic effect on the direction of health policy in the U.S.

Health Care Reform , Patient Protection and Affordable Care Act/legislation & jurisprudence , Politics , Humans
J Gen Intern Med ; 36(3): 775-778, 2021 03.
Article in English | MEDLINE | ID: covidwho-754317


In the midst of the COVID-19 outbreak, health care reform has again taken a major role in the 2020 election, with Democrats weighing Medicare for All against extensions of the Affordable Care Act, while Republicans quietly seem to favor proposals that would eliminate much of the ACA and cut Medicaid. Although states play a major role in health care funding and administration, public and scholarly debates over these proposals have generally not addressed the potential disruption that reform proposals might create for the current state role in health care. We examine how potential reforms influence state-federal relations, and how outside factors like partisanship and exogenous shocks like the COVID-19 pandemic interact with underlying preferences of each level of government. All else equal, reforms that expand the ACA within its current framework would provide the least disruption for current arrangements and allow for smoother transitions for providers and patients, rather than the more radical restructuring proposed by Medicare for All or the cuts embodied in Republican plans.

COVID-19/epidemiology , Health Care Reform/legislation & jurisprudence , National Health Insurance, United States/legislation & jurisprudence , Patient Protection and Affordable Care Act/legislation & jurisprudence , Humans , Medicaid/legislation & jurisprudence , Medicare/legislation & jurisprudence , National Health Insurance, United States/trends , Patient Protection and Affordable Care Act/trends , United States , Universal Health Insurance/legislation & jurisprudence