ECONOMIC REPORT OF THE PRESIDENT

Figure 4-14
Uncompensated Care as a Share of Hospital Costs, 2011–2015
Percent of Hospital Operating Costs
6
Medicaid Non-Expansion States
5
4
3
Medicaid Expansion States
All States
2
1
2015
0
2011 2012 2013 2014 2015
Note: State Medicaid expansion status is as of July 1, 2015. Data for 2015 are incomplete.
Source: Centers for Medicare and Medicaid Services, Hospital Cost Reports; CEA calculations.
particularly likely to receive uncompensated care. In Medicaid expansion
states, uncompensated care as a share of hospital operating costs has fallen
by around half since 2013.
More detailed research using these hospital cost report data has
provided additional evidence that the Affordable Care Act’s coverage provisions,
particularly Medicaid expansion, have driven substantial reductions
in uncompensated care. Dranove, Garthwaite, and Ody (2016) and Blavin
(2016) document similar aggregate trends in uncompensated care, including
differences in trends between expansion and non-expansion states. Dranove,
Garthwaite, and Ody (2016) also look at hospital-level trends in uncompensated
care, finding that reductions in uncompensated care are larger for
hospitals located in areas that had larger numbers of individuals likely to
become eligible for Medicaid under Medicaid expansion.
Reduced Economic Disparities
The ACA’s coverage expansions have also substantially reduced economic
inequality, as discussed in greater detail in Chapter 3. Most directly,
the law has sharply narrowed differences in uninsured rates across population
groups. As illustrated in Figure 4-15 below, the coverage gains from
2010 through 2015 have been broadly shared, with the uninsured rate falling
across all income, age, and race and ethnicity groups. Gains have also been
seen in both urban areas, defined here as counties included in a metropolitan
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