Medicaid Expansion Affects Rural And Urban Hospitals Differently.

Journal Article (Journal Article)

Rural hospitals differ from urban hospitals in many ways. For example, rural hospitals are more reliant on public payers and have lower operating margins. In addition, enrollment in the health insurance Marketplaces of the Affordable Care Act (ACA) has varied across rural and urban areas. This study employed a difference-in-differences approach to evaluate the average effect of Medicaid expansion in 2014 on payer mix and profitability for urban and rural hospitals, controlling for secular trends. For both types of hospitals, we found that Medicaid expansion was associated with increases in Medicaid-covered discharges. However, the increases in Medicaid revenue were greater among rural hospitals than urban hospitals, and the decrease in the proportion of costs for uncompensated care were greater among urban hospitals than rural hospitals. This preliminary analysis of the early effects of Medicaid expansion suggests that its financial impacts may be different for hospitals in urban and rural locations.

Full Text

Duke Authors

Cited Authors

  • Kaufman, BG; Reiter, KL; Pink, GH; Holmes, GM

Published Date

  • September 1, 2016

Published In

Volume / Issue

  • 35 / 9

Start / End Page

  • 1665 - 1672

PubMed ID

  • 27605649

Electronic International Standard Serial Number (EISSN)

  • 1544-5208

Digital Object Identifier (DOI)

  • 10.1377/hlthaff.2016.0357


  • eng

Conference Location

  • United States