Research Roundup: Maternal ‘Churn’; The ACA And Hospitals’ Bottom Lines

Health Affairs: Women In The United States Experience High Rates Of Coverage ‘Churn’ In Months Before And After Childbirth
Insurance transitions—sometimes referred to as “churn”—before and after childbirth can adversely affect the continuity and quality of care. ... Using nationally representative survey data for the period 2005–13, we found high rates of insurance transitions before and after delivery. Half of women who were uninsured nine months before delivery had acquired Medicaid or CHIP coverage by the month of delivery, but 55 percent of women with that coverage at delivery experienced a coverage gap in the ensuing six months. Risk factors associated with insurance loss after delivery include not speaking English at home, being unmarried, having Medicaid or CHIP coverage at delivery, living in the South, and having a family income of 100–185 percent of the poverty level. (Daw et al., 4/3)

Health Affairs: Low-Income Children With Chronic Conditions Face Increased Costs If Shifted From CHIP To Marketplace Plans
More than eight million children risk having their health insurance coverage disrupted if federal funding for the Children’s Health Insurance Program (CHIP) is not extended beyond 2017. In this study we explored two current policy alternatives: extending federal funding for CHIP or enrolling children in the existing health insurance Marketplace plans. ... If CHIP funding is not renewed and children with chronic conditions shift to coverage under Marketplace plans, their families face increased annual out-of-pocket expenses ranging from $233 at the lowest income levels to $2,472 at the highest income level of 251–400 percent of poverty. Families with children who have epilepsy, diabetes, or mood disorders may face the highest costs. Cost sharing for prescription drugs (25 percent) and hospitalizations (23 percent) account for much of the difference. (Peltz et al., 4/3)

Urban Institute: How Has The ACA Changed Finances For Different Types Of Hospitals? Updated Insights From 2015 Cost Report Data
This study estimates the effects of the ACA on hospital finances in 2015 and how they differ between hospitals in states that expanded Medicaid and hospitals in states that did not expand Medicaid. ... it expands upon a 2016 study .... this new analysis finds that the Medicaid expansion under the ACA increased Medicaid revenue by $5.0 million per hospital, reduced costs of uncompensated care by $3.2 million per hospital, and improved average operating margins by 2.5 percentage points. This study also finds that the financial benefits of the Medicaid expansion on hospitals’ profit margins were strongest for small hospitals, for-profit and non-federal-government-operated hospitals, and hospitals located in nonmetropolitan areas. (Blavin, 4/3)

The Kaiser Family Foundation: Estimates: Average ACA Marketplace Premiums For Silver Plans Would Need To Increase By 19% To Compensate For Lack Of Funding For Cost-Sharing Subsidies
[T]he average premium for a benchmark silver plan in Affordable Care Act (ACA) marketplaces would need to increase by an estimated 19 percent for insurers to compensate for lost funding if they don’t receive federal payment for ACA cost-sharing subsidies. Established by the health law to reimburse insurers for the cost of reducing out-of-pocket costs for lower-income people buying marketplace plans (with incomes from 100% to 250% of the poverty level), the subsidies have been challenged in a lawsuit from the U.S. House. ... The analysis ... finds that the estimated premium increase for silver plans would be higher (21%) in states that did not expand Medicaid under the ACA than in states that expanded Medicaid (15%). ... Estimated premium changes vary for the 38 states that used healthcare.gov in 2016, ranging from 9 percent in North Dakota to 27 percent in Mississippi. (4/6)

Commonwealth Fund: Medicaid Cuts Would Affect Older, Sicker Americans
Medicaid has been the subject of debate recently—with issues raised about eligibility, financing, and potential work requirements for beneficiaries. More fundamentally, there have been questions about who Medicaid covers and how well it helps them. According to data from the Commonwealth Fund’s Survey of High Need Patients, nearly half of adults with Medicaid are 50 or older; many have multiple chronic conditions, behavioral health problems, or physical limitations or disabilities. Any changes to the Medicaid program could disproportionately affect many of our neediest, sickest Americans. (Ryan and Abrams, 4/6)