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ACA Medicaid Expansion Reducing Uncompensated Care

The Affordable Care Act's Medicaid expansion is doing what Tim Johnson, Stan Adelstein, and Joe Lowe have said it would do in states smart enough to adopt it. More people are getting affordable health care, and hospitals are seeing lower rates of uncompensated care, the costs that hospitals forgive uninsured patients and spread out to the rest of us.

  1. In a survey of 465 hospitals in 30 states, the Colorado Hospital Association finds average charity care in Medicaid expansion states has dropped 30% in one year. Average charity care in ACA-embracing Colorado has decreased 36% in urban hospitals and 38% in rural hospitals. In anti-ACA states, charity care has increased 11%.
  2. Arkansas Governor Mike Beebe says hospitals in his Medicaid-expanding state saw a 24% drop in uninsured emergency room visits and a 30% drop in uninsured hospital admissions in the first quarter of this year.
  3. Tenet Healthcare finds a 33% decrease in uninsured and charity inpatient admissions and a 24% decrease in uninsured and charity outpatient visits in four Medicaid expansion states. The non-expansion states in its fold saw a 2% increase in uninsured and charity inpatient admissions and a 10% decrease in those cost-risky outpatient visits.

Numbers, numbers, numbers: expand Medicaid, and hospitals are more likely to get payment for treating the sick and injured.

Oh yeah: and it's nice to help more people get well.


  1. Loren 2014.06.18

    A real Homer Simpson moment for Gov. Dudley Doogood, "DOH!!"

  2. Rorschach 2014.06.18

    It's great to see people get the preventative health care they need rather than having to resort to the emergency room. It's great to see hospitals getting paid for their services albeit at a reduced rate.

    But the flip side to this coin is that most hospitals are non-profit entities that are expected to provide some charity care in exchange for their largely tax free status. Our local hospitals are not ranked very high in the percentage of revenue they dedicate to helping people who can't afford care. When we expand Medicaid (when, not if) will our local hospitals simply redirect their charity care budget to the monopoly game they are playing and to building more sports facilities with their names on them? At what point do we ask them to pay taxes like other businesses?

  3. Jerry 2014.06.18

    So now you know the real truth, the ACA is not about saving lives nor is it about saving money. The ACA is all about President Obama. The last thing a racist governor and his racist legislature want is to have anything to do with the black man in the white house. Check out the republican party and what it stands for...Doesn't take too long, they stand for nothing anymore. No support of the military (only if it is killing), certainly no support of veterans and veteran issues. They are hollow. What they have though, is money, lots and lots of it. So the governor has now punted this over to the legislature and there you have have a mixed bag of losers that hate minorities and especially the white working poor. Even though it will cost all South Dakotan's more money to pay for services without Medicaid Expansion than with it, that does not matter. The racist republicans have shown they can stand on the backs of the sick working poor to give Obama the finger.

  4. Stan Gibilisco 2014.06.18

    Ach! The snark tags failed to show up in production! I wonder ... maybe I was in fact serious and just forgot it. You know, memory is the second thing to go in old mountain coots.

  5. Anne Beal 2014.06.18

    So if the cost of uncompensated care are going down, it should follow that the bills the rest of us pay should also go down.
    When Hillary made her campaign stop in Sioux Falls in 2008 she said the cost-shifting was costing each of us $800/year. So.... Where Medicaid expansion has occurred, have people seen a reduction in their medical bills?

    I didn't think so.

  6. Jerry 2014.06.18

    Yes Anne, the cost is going down as that was the reason of the article you read. When you say bills the rest of us pay, do you mean bills the insurance company pays?

  7. bearcreekbat 2014.06.19

    I thought South Dakota conservatives were opposed to unnecessary taxation. In South Dakota we have a law on the books called County Poor Relief (SDCL ch 28-13) that requires every single county to pay for necessary medical expenses for indigents. (SDCL 28-13-1.3) Over the years several hospitals have filed successful suits against various counties to enforce this law and obtain reimbursement for huge medical expenses incurred by indigents. This created such a financial burden on local property taxes that in 1984 the state enacted the Catastrophic County Poor Relief Fund to help counties that got stuck paying catastrophic medical bills for indigents. (SDCL 28-13a).

    Pennington County auditor's records show that Pennington County has imposed uncollectible medical indigent liens for medical costs of about $3.5 million dollars over the last ten years.

    The Medicaid expansion would cover 100% of those costs because it covers the same group of individuals and families that County Poor Relief now must cover with property tax dollars. The money saved in property taxes could be used for schools and myriad other purposes, including stabilizing the taxes rather than increasing them.

    This seems to mean that the real issue we face is how to pay for medical care for indigents - with 100% local property tax dollars, supplemented by state catastrophic funds in extreme cases, or with 90% to 100% federal dollars. I realize that despite its conservative politicians' anti-federal posturing, our state already collects much more in federal money that we pay out in federal taxes. Perhaps the Governor just feels guilty about that point, and has decided it really is better to increase property taxes on South Dakotans to cover indigents' medical expenses rather than accept more funds from the feds?

  8. mike from iowa 2014.06.19

    A few years ago one mainstream network did a program on what hospitals charge uninsured patients versus what they charge insured patients. Uninsured were charged the highest costs for every procedure and then the bills were turned over to collection agencies. Insurers negotiate costs and payments with hospitals (just like the fed) and get enormous discounts on prices and then the hospitals get paid upfront. The poor,as usual,get the shit end of the stick.

  9. Jerry 2014.06.19

    Excellent post bearcreekbat, or they could go to the Homeland Security well and declare the indigents as terrorists to get the money. What does not surprise me is that the majority of South Dakotans want this Medicaid Expansion and the governor knows this. That is why he is putting the blame of obstruction onto the legislature instead of showing leadership to put it into law.

  10. caheidelberger Post author | 2014.06.19

    Indeed, bearcreekbat! Joe Lowe spoke on the indigent care/county budget issue with respect to ACA Medicaid expansion during the primary. That's an issue Susan Wismer should add to her campaign repertoire.

  11. Roger Cornelius 2014.06.19

    It might interest you to know that Pennington County does not cover indigent care for residents of Rapid City.
    I have never been given a satisfactory answer to this question, other than Pennington County saying "we just don't cover Rapid City".

  12. caheidelberger Post author | 2014.06.19

    What?! Roger, how can the county not cover city residents? Does the city offer some comparable program that excuses the county from its obligations?

  13. Roger Cornelius 2014.06.19

    No the city doesn't have an comparable program to the county for indigent coverage, Rapid City citizens are referred to state Health and Human Services, this referral is primarily for traumatic healthcare.
    Non-emergency health needs are handled by Community Health Center of the Black Hills which handles all cases on a sliding fee.
    Like I said, I have never understood why Rapid City is not considered a part of Pennington County when it comes to indigent healthcare.

  14. bearcreekbat 2014.06.19

    Cory, I was extremely disappointed when I saw no mention of this problem in Susan Wismer's recent RC Journal interview. I thought property taxes would be an important issue in our tax conscious state. Let's hope she addresses it in the general.

    Roger, I am unaware of any provision that would allow Pennington County to exclude Rapid City residents from Poor Relief coverage. It would not surprise me, however, if an administrator arbitrarily decided to exclude anyone. I know that various counties have been sued in federal court more than once for similar arbitrary exclusions unauthorized by state law. In every single case that I am aware of the county's arbitrary exclusion policies have been declared illegal and the county has been on the hook for the plaintiff's attorney's fees under 42 USC 1988.

  15. Roger Cornelius 2014.06.19


    I'm aware of some of those court filings and the results, usually in the challengers favor.
    Pennington County is screwed up. When I was the on the community health board the county would allow a couple of thousand a month to take care of indigent health needs.
    That would allow us to help those with zero income, but it did not allow for any catastrophic or trauma care, Regional likely eats those costs.
    Now here is the clincher, community health paid $2,000 a month to Pennington County Detox for services we provided to inmates and clients.
    So, at the end of the year, between what the county paid to community health and what community health paid to detox it all came out about even.

  16. Jerry 2014.06.19

    Sounds to me like a lawsuit needs to be filed on this to get the matter adjudicated and put the county as having the responsibility of payments. This is not right. In this case, how would you do that?

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