How Much Has the Affordable Care Act Reduced the Share of Uninsured Patients Treated by the City’s Public Hospitals?

With the full implementation of the Affordable Care Act, the share of adults in New York City without health insurance dropped from 20.9 percent in 2013 to 13.8 percent in 2014, a 7.1 percentage point decline. To gauge the effect on New York City Health + Hospitals, we focus on adult outpatient visits to H + H hospitals and diagnostic and treatment centers because some conditions that require inpatient stays, such as medical emergencies, allow for temporary Medicaid eligibility.

  • Although the city’s public hospital system saw a reduction in the share of outpatient visits by uninsured adults, the decline was less steep—4.0 percentage points—than the city as a whole.
  • In 2015, the share of H + H’s outpatient visits by uninsured adults (25.2 percent) was 11.4 percentage points greater than the share of uninsured adults in the general population.
  • For both the city’s population and H + H’s patients, those adults who gained health insurance did so through Medicaid or commercial insurance in approximately equal proportions.

  • Both the share of adult outpatient visits by uninsured patients and the impact of the Affordable Care Act on this share vary widely across H + H facilities.
  • The hospital centers serving the largest shares of adult outpatients who are uninsured include Elmhurst, Queens, Bellevue, and Woodhull.
  • Although each of these four hospital centers saw declines in the share of adults without insurance from 2013 through 2015, all of the decreases fell short of the reduction in the share of uninsured for the city as a whole. Woodhull saw by far the smallest decline, 1.8 percentage points.

Prepared by Erin Kelly
 New York City Independent Budget Office

Print version available here.

SOURCES Department of Health & Mental Hygiene, New York City Community Health Survey, 2014. Health & Hospital Corporation Payor Mix Reports, September 2015 and September 2014, as reported to the Finance Committee.
NOTES: For the share of outpatient visits by uninsured adults at H + H facilities, pre-Affordable Care Act reflects fiscal year 2013 and post-Affordable Care Act reflects fiscal year 2015. For the share of New York City adults who are uninsured, pre-Affordable Care Act reflects calendar year 2013 and post Affordable Care Act reflect calendar year 2014, as reported by the Department of Health and Mental Hygiene Community Health Survey for those years. Coney Island Hospital is not included in the chart breaking out visits by facility because Hurricane Sandy had a lasting impact on the number of visits the hospital was able to provide in 2013 and 2014.

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