Alexander Report got it wrong on charity care and health expansion

Photo: Bangor Daily News l Kevin Bennett

During the recent debate over Medicaid expansion in Maine, Maine hospitals supported expanding the program and argued that doing so would limit the amount of charity care they would provide.

In contrast, its foes claimed that expanding wouldn’t reduce the number of uninsured people going to hospitals.

The first Alexander Report (p.48) argued that expanding public health insurance would basically just replace private health insurance, yielding no net decline in uninsured individuals needing charity care.

Data from around the country show the hospitals were right.

Expansion states are seeing sharp reductions in the number of uninsured people seeking care.

Reporter Jason Millman went through reports by publicly traded hospitals to see what happened when some states expanded Medicaid and others didn’t.

Here’s what he found:

1. The Hospital Corporation of America operates in 20 states. According to its chief financial officer, its hospitals “had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions.”

2. Tenet Healthcare reported that “uninsured visits decreased 33 percent in the four expansion states where it operates.” But in states that didn’t expand, “uninsured care rose 2 percent.” 

3. Community Health Systems has facilities in 26 states. “Self-pay emergency room visits decreased 16 percent in expansion states, but they increased in non-expansion states.”

We already knew that Medicaid expansion is life-saving, with stories from expansion states like Arkansas incredibly striking and heart-warming.

Now Montana, a state that Romney won convincingly in 2012, is looking at an Arkansas-like model right now. (New Hampshire’s Medicaid expansion uses the same sort of system, a so-called private option.) And conservative Republican Governor Mike Pence of Indiana, another state Romney won, has an interesting proposal for Medicaid expansion.

Findings that uninsured visits to hospitals dropped in Medicaid expansion states should encourage more states to adopt it — that is, if evidence matters.

Maine could be seeing similar trends, as its hospitals expected, if most Maine Republican legislators and Gov. LePage had not blocked expanding Medicaid.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.