To examine the impact of the Affordable Care Act's coverage expansion on safety‐net hospitals (s).
Nine Medicaid expansion states.
Differences‐in‐differences () models compare payer‐specific pre‐post changes in inpatient stays of adults aged 19–64 years at s and non‐s.
2013–2014 Healthcare Cost and Utilization Project State Inpatient Databases.
On average per quarter postexpansion, s and non‐s experienced similar relative decreases in uninsured stays ( = –2.2 percent, =.916). Non‐s experienced a greater percentage increase in Medicaid stays than did s ( = 13.8 percent, =.041). For s, the average decrease in uninsured stays (–146) was similar to the increase in Medicaid stays (153); privately insured stays were stable. For non‐s, the decrease in uninsured (–63) plus privately insured (–33) stays was similar to the increase in Medicaid stays (105). s and non‐s experienced a similar absolute increase in Medicaid, uninsured, and privately insured stays combined ( = –16, =.162).
Postexpansion, non‐s experienced a greater percentage increase in Medicaid stays than did s, which may reflect patients choosing non‐s over s or a crowd‐out of private insurance. More research is needed to understand these trends.