Luo Qian, Moghtaderi Ali, Markus Anne, Dor Avi
Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute of Public Health, The George Washington University, Washington, District of Columbia, USA.
Department of Health Policy and Management, Milken Institute of Public Health, The George Washington University, Washington, District of Columbia, USA.
Health Serv Res. 2022 Jun;57(3):634-643. doi: 10.1111/1475-6773.13897. Epub 2021 Oct 27.
To determine the impacts of the Medicaid expansion on revenues, costs, assets, and liabilities of federally funded community health centers.
We combined data from the Uniform Data System, Internal Revenue Service nonprofit tax returns, and county-level characteristics from the Census Bureau. Our final dataset included 5841 center-year observations.
We used difference-in-differences model to estimate the fiscal impacts of the Medicaid expansion on community health centers. We employed event study models, state-specific trend models, and placebo law tests as robustness checks.
Not applicable.
On the revenue side, we found a $2.08 million relative increase (p = 0.002) in Medicaid revenues, offset by a $0.44 million decrease (p = 0.015) in total grants among community health centers in expansion states compared with centers in non-expansion states. On the expenditure side, we found a large but not statistically significant $0.98 million relative increase (p = 0.201) in total expenditures among centers in expansion states. Uncompensated care for health centers in expansion states decreased by $1.19 million (p < 0.001) relative to their counterparts in non-expansion states.
Community health centers in expansion states benefited from the increased, stable revenue stream from Medicaid expansions. While Medicaid revenue increased as a result of the policy, we find no major evidence of substitution away from other revenue lines, with one notable exception (i.e., substitution away from state and local government grants). From a policy perspective, these results are encouraging as the Biden Administration starts to implement the safety-net enhancements from the American Rescue Plan Act of 2021 and as more non-expansion states are considering opting into Medicaid expansions. It is anticipated that these added revenue streams will help to sustain health centers in the delivery of health care services to the underserved population.
确定医疗补助扩大计划对联邦资助的社区卫生中心的收入、成本、资产和负债的影响。
我们将统一数据系统、美国国税局非营利组织纳税申报单以及人口普查局的县级特征数据相结合。我们的最终数据集包含5841个中心年度观测值。
我们使用差异-in-差异模型来估计医疗补助扩大计划对社区卫生中心的财政影响。我们采用事件研究模型、特定州趋势模型和安慰剂法检验作为稳健性检验。
不适用。
在收入方面，我们发现与非扩大计划州的社区卫生中心相比，扩大计划州的社区卫生中心医疗补助收入相对增加了208万美元（p = 0.002），但总拨款减少了44万美元（p = 0.015），两者相互抵消。在支出方面，我们发现扩大计划州的社区卫生中心总支出相对增加了98万美元，但在统计学上不显著（p = 0.201）。与非扩大计划州的同行相比，扩大计划州的社区卫生中心无偿医疗服务减少了119万美元（p < 0.001）。
扩大计划州的社区卫生中心受益于医疗补助扩大计划带来的收入增加和稳定。虽然该政策导致医疗补助收入增加，但我们没有发现从其他收入来源大量替代的主要证据，只有一个显著例外（即从州和地方政府拨款中替代）。从政策角度来看，随着拜登政府开始实施2021年《美国救援计划法案》中的安全网增强措施，以及更多非扩大计划州考虑选择加入医疗补助扩大计划，这些结果令人鼓舞。预计这些新增的收入来源将有助于维持卫生中心为弱势群体提供医疗服务。
