Hwang Wenke, Griffin Leah, Liao Kimberly, Hall Mark
Department of Public Health Sciences, Division of Health Services Research, Penn State University College of Medicine, Hershey, PA 17033, USA.
N C Med J. 2012 Jul-Aug;73(4):263-8.
The Affordable Care Act gives states the option to expand state Medicaid programs to cover many who are currently uninsured. The potential financial impact has not been thoroughly examined. We characterized the health risk of uninsured adults in Buncombe County, North Carolina, relative to that of local Medicaid recipients, to estimate the cost of expanding Medicaid coverage to include the uninsured.
We obtained de-identified patient enrollment and claims data for 2008 from the Division of Medical Assistance, North Carolina Department of Health and Human Services and from the 3 safety-net providers who care for most of the county's low-income uninsured adults. We used the Chronic Illness and Disability Payment System (CDPS) risk-adjustment tool to measure the relative health risk of the two populations. Based on actual spending in the Medicaid group and its health risk relative to that of the uninsured, we then projected how much it would have cost to provide Medicaid coverage for these uninsured in 2008.
We estimated, based on CDPS adjustment for demographics and diagnoses, that these uninsured adults would have incurred costs 13% greater than those of the actual nondisabled adult Medicaid population. The projected cost of providing Medicaid coverage to these uninsured would have been $4,320 per person.
Data were drawn from only the 3 major safety-net organizations and therefore excluded care obtained from other safety-net providers. Also, this sample of uninsured people included some who are ineligible for Medicaid because of their citizenship status. Furthermore, Medicaid enrollment might lead to increased utilization, revealing a greater burden of illness than we detected.
In Buncombe County, uninsured adults who enroll in expanded Medicaid are likely to have somewhat more costly health problems than do currently enrolled nondisabled adults.
《平价医疗法案》赋予各州选择扩大州医疗补助计划覆盖范围的权力，以涵盖许多目前未参保的人群。其潜在的财务影响尚未得到全面审查。我们对北卡罗来纳州本康伯县未参保成年人相对于当地医疗补助受益人的健康风险进行了特征描述，以估计将医疗补助覆盖范围扩大至未参保人群的成本。
我们从北卡罗来纳州卫生与公众服务部医疗救助司以及该县大多数低收入未参保成年人的3家安全网医疗机构获取了2008年去识别化的患者登记和理赔数据。我们使用慢性病与残疾支付系统（CDPS）风险调整工具来衡量这两类人群的相对健康风险。基于医疗补助群体的实际支出及其相对于未参保人群的健康风险，我们随后预测了2008年为这些未参保人群提供医疗补助覆盖所需的成本。
基于对人口统计学和诊断的CDPS调整，我们估计这些未参保成年人产生的费用将比实际非残疾成年医疗补助人群高13%。为这些未参保人群提供医疗补助覆盖的预计成本为每人4320美元。
数据仅来自3家主要的安全网组织，因此未包括从其他安全网医疗机构获得的医疗服务。此外，这个未参保人群样本包括一些因公民身份而无资格获得医疗补助的人。此外，医疗补助登记可能导致利用率提高，显示出比我们所检测到的更大的疾病负担。
在本康伯县，参加扩大后的医疗补助计划的未参保成年人可能比目前参保的非残疾成年人有成本更高的健康问题。
