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ACA: Surgeons assess the impact of the Affordable Care Act

The American College of Surgeons asked members of its Board of Governors to report on the effect of the Affordable Care Act on their surgical practice.  The following findings are based on responses from 208 U.S. surgeons.

  • There are more people who have health insurance
  • There are more people who have Medicaid coverage
  • There is a slight increase in surgical caseload
  • However, more patients are delaying elective surgery
  • And the surgeons report that patients are first coming for care at a later stage of disease

Source: Puls, M.W. (2016, May). 2015 ACS Governors Survey: Surgeons describe the ACA’s effects on access to care. Bulletin of the American College of Surgeons, 101(5), 19-24.  Click here: http://bulletin.facs.org/2016/05/2015-acs-governors-survey-surgeons-describe-the-acas-effects-on-access-to-care/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

HEALTH INSURANCE : 10 states with highest number of uninsured in 2014

These are authoritative numbers from the Medicaid and CHIP Payment and Access Commission that compare each state according to the number of uninsured residents in 2014 compared to 2013.

States with Highest Number of Uninsured (2014)

  1. 5,047,000 Texas
  2. 4,767,000 California
  3. 3,245,000 Florida
  4. 1,697,000 New York
  5. 1,568,000 Georgia
  6. 1,276,000 North Carolina
  7. 1,238,000 Illinois
  8. 1,065,000 Pennsylvania
  9.    965,000 New Jersey
  10.    955,000 Ohio

US Total = 36,670,000 (2014) – which represents a drop of 8,510,000 from 2013 to 2014 nationally.

States with Highest Percentage of Uninsured (2014)

  1. 19.1 percent Texas
  2. 17.2 percent Alaska
  3. 16.6 percent Florida
  4. 15.8 percent Georgia
  5. 15.4 percent Oklahoma
  6. 15.2 percent Nevada
  7. 14.8 percent Louisiana
  8. 14.5 percent Mississippi
  9. 14.5 percent New Mexico
  10. 14.2 percent Montana

US Total = 11.7 percent (2014) – which represents a drop of 2.8 percent from 2013 to 2014 nationally.

Source: Medicaid and CHIP Payment and Access Commission (2016, Mar.). Report to Congress on Medicaid and CHIP (p. 47). Washington, D.C.: MACPAC.  Click here for full text https://www.macpac.gov/wp-content/uploads/2016/03/March-2016-Report-to-Congress-on-Medicaid-and-CHIP.pdf

Of Related Interest: Collins, S.R., Gunja, M. and Beutel, S. (2015, Sept. 16). New Census data show the number of uninsured Americans dropped by 8.8 million. The Commonwealth Fund Blog. http://www.commonwealthfund.org/publications/blog/2015/sept/us-census-data-shows-uninsured-americans-drop Posted by AHA Resource Center (312) 422-2050, rc@aha.org





WORKFORCE: U.S. physician supply and demand projections to 2025 – trends analysis

This is an analysis of U.S. national supply and demand for doctors published by an authoritative source.  Here are some findings:

  • Overall shortfall of between 46,100 to 90,400 physicians by the year 2025 – driven by steep increase in demand
  • Primary care shortfall of 12,500 to 31,100 physicians by the year 2025
  • Affordable Care Act (ACA) will ultimately increase demand for physician care that will call for 16,000 to 17,000 more doctors
  • The shortfalls projected in this study are a smaller than an earlier study done in 2010
  • Surgeons are going to be in greater demand because the analysts predict limited growth in the number of surgeons and also because there is limited ability to have other advanced practice clinicians take some of their workload

This study is also of interest because of the development of various planning scenarios.  Among the topics addressed include trends among:

  • Physician assistants
  • Immigration reform
  • Avoidable hospitalization
  • Concierge medicine
  • Technology development

There is an interesting table projecting demand in different care settings related to changing demographics in the U.S. compared to the effect of the expansion of coverage due to the ACA.

Growth in Demand by Location of Care: 2013 to 2025

Hospital inpatient days are forecast to increase 23 percent due to demographic shifts and only 1 percent due to the ACA.

Emergency department visits are forecast to increase 12 percent due to demographics and 0 percent due to the ACA.

Source: IHS, Inc. (2015, Mar.). The complexities of physician supply and demand: Projections from 2013 to 2025, final report. Washington, D.C.: Association of American Medical Colleges.  https://www.aamc.org/download/426242/data/ihsreportdownload.pdf

UNINSURED: Number of Americans lacking health insurance has decreased to 28.5 million in 2015

The number of Americans without health insurance has been decreasing, according to a survey conducted each year by the National Center for Health Statistics.  In 2010, there were an estimated 48.6 million Americans without health insurance.  As of the first half of 2015, that number had dropped to 28.5 million.  Let’s do the math.  That’s an improvement of 20 million people.

And for children, the results are also heartening.  In 2010, an estimated 5.8 million children were uninsured.  By the first half of 2015, that number had decreased to 3.3 million.  An improvement of 2.5 million.

Uninsured at the Time They Were Surveyed (all ages)

  • 48.6 million, or 16 percent (2010)
  • 46.3 million, or 15.1 percent (2011)
  • 45.5 million, or 14.7 percent (2012)
  • 44.8 million, or 14.4 percent (2013)
  • 36 million, or 11.5 percent (2014)
  • 28.5 million, or 9 percent (first half 2015)

These are federal government estimates based on the results of a sample survey of the civilian noninstitutionalized population of the United States.

Source:  Martinez, M.E., and Cohen, R.A. (2015, Nov.). Health insurance coverage: Early release of estimates from the National Health Interview Survey, January-June 2015. National Health Interview Survey early release program. Retrieved from http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201511.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


ACA Insurance Expansion and Uncompensated Hospital Care Costs

Hospital uncompensated care costs were $7.4 billion less in 2014 than they would have been if insurance coverage had remained at 2013 levels. That’s according to an updated analysis by HHS, based on estimated 2014 growth in insurance coverage due to the Affordable Care Act. It’s a 21% decrease in hospital uncompensated care between 2013 and 2014.

Medicaid expansion accounted for a significant portion of the uncompensated cost savings in states that expanded Medicaid versus those states that didn’t. An additional $1.4 billion in uncompensated costs might have been saved if the the non-expansion states had increased Medicaid coverage.

Here are the numbers from the report:

Hosp uncompensated care reduction & ACA

Furthermore, HHS analyzed hospital financial reports and found the volume of uninsured/self-pay admissions has fallen in major hospital systems, with a significant drop in states with Medicaid expansion.


Source: Insurance expansion, hospital uncompensated care, and the Affordable Care Act. US Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, March 23, 2015. http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_UncompensatedCare.pdf

Related resources:

Economic impact of the Medicaid expansion. US Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, March 23, 2015. http://aspe.hhs.gov/health/reports/2015/MedicaidExpansion/ib_MedicaidExpansion.pdf

Uncompensated hospital care cost fact sheet. American Hospital Association, Jan. 2015. http://www.aha.org/content/15/uncompensatedcarefactsheet.pdf

See also earlier post: https://aharesourcecenter.wordpress.com/2014/09/26/impact-of-insurance-expansion-on-hospital-uncompensated-costs-in-2014/

Posted by AHA Resource Center (312) 422-2050, rc@aha.org