Trends in hospital ED closures nationwide and across Medicaid expansion, 2006-2013.
OBJECTIVE
Low reimbursement from the uninsured has been claimed to threaten hospital finances and even hospital emergency department (ED) closure. We hypothesized in advance of beginning data collection that states that expanded Medicaid ("expansion states") under the 2010 Patient Protection and Affordable Care Act would experience a reduced rate of ED closure compared with states that did not.


METHODS
We compiled a national census of EDs from 2006 through 2013 from federal databases and manually confirmed each closure. We used difference-in-differences regression on this longitudinal panel to compare the probability over time that a hospital was in operation in expansion states to nonexpansion states.


RESULTS
The number of hospitals grew every year nationally and in nonexpansion states. In expansion states, the number fell from 2027 in 2009 to 2019 in 2010, not surpassing the 2009 peak until 2012. In regression estimates, hospitals in expansion states were 2.2% (95% confidence interval, 0.3%-4.1%) less likely to be in operation after 2010 compared with the trend in nonexpansion states.


CONCLUSIONS
States that expanded Medicaid experienced increased, rather than reduced, ED closure rates from 2010 through 2013. The financial benefits of the Affordable Care Act may be poorly targeted to the hospitals most vulnerable to closure.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: arib@alumni.upenn.edu.
Ari B
AB
Friedman
Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA.
D Daphne
DD
Owen
School of Public and Environmental Affairs, Indiana University, Bloomington, IN.
Victoria E
VE
Perez
D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006271:Health Facility Closure / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008484:Medicaid; D058991:Patient Protection and Affordable Care Act; D014481:United States