- Major health insurance coverage expansions are not associated with increases in hospital use, but have resulted in redistribution of usage among various populations, according to a new Annals of Internal Medicine report.
- Researchers looked at how hospital use changed after Medicare and Medicaid was introduced in the 1960s as well as after the Affordable Care Act expanded coverage.
- Study authors concluded that policies promoting universal coverage, such as "Medicare for All" or adding a public option that some Democratic presidential contenders have proposed "is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained."
Universal coverage in the United States is still a long way off, but more Democrats are drafting plans to achieve it — and patients, policymakers and academics are taking a closer look at its potential ramifications.
Hospitals are fiercely opposed to Medicare for All, a way of achieving universal coverage that would represent a major change to the status quo. They've lobbied against the idea, including claiming such a plan would overwhelm hospitals with newly covered patients.
The new research casts doubt on that idea.
It found overall hospital discharges in the years just before the ACA, for example, were are 9.4 per 100 people and barely changed to 9.0 per 100 after implementation. The same was true for before and after Medicare and Medicaid were put into place, though the discharges were higher at just below 13 per 100 people.
Study author Adam Gaffney, with Harvard Medical School and Cambridge Health Alliance, told Healthcare Dive the results showed how hospitals and providers might adjust if universal coverage is introduced and "should assuage concerns that Medicare for All would lead to some surge in use and some surge in costs."
After healthcare coverage expanded, providers suggested fewer elective and sometimes unnecessary procedures for those who have had coverage, said Gaffney, who is also president of Physicians for a National Health Program, which advocates for universal coverage.
"That's probably a good thing for all the parties given the fact that, as the Institute of Medicine once reported, up to a third of healthcare dollars are wasted in this country," he said.
But Medicare for All has many opponents in addition to hospitals.
Republicans have termed it socialism and, on Monday, CMS Administrator Seema Verma called such proposals "the largest threats to the American healthcare system."
Although many providers are on the record opposing Medicare for All, there are some who support it, and there are signs the tide may be shifting. At the American Medical Association's annual meeting last month, members did vote to continue to oppose a single-payer healthcare system for the U.S., but the margin was slim.
American College of Physicians SVP for Public Policy Bob Doherty said at the time the outcome "would have been unimaginable in years past."
The Congressional Budget Office noted earlier this year in a report on single-payer policies that if "the number of providers was not sufficient to meet demand, patients might face increased wait times and reduced access to care," but the authors said these effects could be mitigated by regulatory changes.