



Jason Millman has been listening in on earnings calls for publicly traded hospital chains, and he says they all report a big difference in admissions between states that expanded Medicaid and those that didn’t:

The Hospital Corporation of America…saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said. Community Health Systems, with facilities in 29 states, also noticed an expansion gap. In expansion states it serves, CHS said it saw self-pay [i.e., uninsured] admissions drop 28 percent while Medicaid admissions increased by 4 percent. Self-pay emergency room visits decreased 16 percent in expansion states, but they increased in non-expansion states, the company said in its earnings call last week. Tenet Healthcare reported last week that it had a 17 percent increase in Medicaid inpatient visits while uninsured visits decreased 33 percent in the four expansion states where it operates. In non-expansion states, Medicaid admissions dropped 1 percent as uninsured care rose 2 percent.

This is why hospitals support Medicaid expansion so strongly. Medicaid may not pay a lot, but on average it pays a lot better than uninsured patients. A drop of around 30 percent in uninsured admissions is a big win for the patients, but it’s also a big win for the hospitals.

Normally, of course, that would be enough to gain Republican support all by itself, but not in the world of Obamacare. The fact that Medicaid expansion benefits the poor, benefits hospitals, probably benefits state finances, and is all but free to participating states—well, it’s just not enough. Demonstrating their tribal opposition to all things Obama is far more important.