New recipients of Medicaid benefited, too. After one year, adults who gained the coverage were 55% more likely to have their own doctor than those who did not, Kaiser found. Medicaid also increased the likelihood of receiving preventive care, such as mammograms and cholesterol checks.
A Tale of Two Hospitals
Both Cook County and Grady are safety-net hospitals based in urban counties where the poverty level is slightly higher than the national average, and both have handled high numbers of uninsured clients in recent years: about half of the patients at Cook and nearly a third at Grady.
Since Obamacare took effect, the numbers at the Georgia hospital have remained about the same. But things have changed dramatically at the Illinois hospital, in large part due to the area’s enrollment of about 170,000 of an estimated 330,000 eligible for the expanded Medicaid.
“This has been a sea change for us,” said Dr. John Jay Shannon, Cook County Health’s chief executive.
Within two years, the percent of uninsured patients at the hospital had dropped from more than a half to about a third, almost entirely driven by increased Medicaid coverage, hospital data show. And for the first time in the hospital’s history, a majority of the patients it treated had coverage.
A third of the new Medicaid enrollees treated at Cook County were patients new to the system. And, hospital administrators say, those with chronic diseases such as diabetes, who used to be frequent emergency room visitors, now have personal physicians to help them manage their conditions.
In the fiscal year ending in November 2014, uncompensated charity care dropped to $342 million from $500 million the year before. Funding from Medicaid nearly doubled the health system’s operating revenues, a major reason that, after ending 2013 with a net loss of $67.6 million, Cook County Health finished its most recent fiscal year in the black.
Now, the provider, like other safety-net hospitals, has a new challenge: holding onto old clients.
“For the first time in our history, we need to compete for our patients,” said Shannon. “A world of improved access is also a world of choice.”
At Grady Health System in Atlanta, meanwhile, the number of patients covered by insurance increased by less than 2% last year. Bad debt from unpaid bills has continued to climb, to $396 million from $269 million in 2013. And the percentage of patients covered by Medicaid didn’t change.