Health Outcomes, Healthcare Systems, and State and Local Health Policy…

MuniNet Guide’s Healthcare page provides articles and analysis of policy recommendations and issues from leading public and private organizations specializing in healthcare, particularly as it affects cities and states. We also provide charts and analysis on the fiscal health of healthcare systems, which are important not only to investors, but also indicate the ability of the health industry to provide care in a sustainable way. Changes in trends of fiscal measures also reflect changes in policy, providing evidence of success and failure.

Fiscal Trends in Hospital Systems:   Hospital Margins for 2017 Dive to Lowest Levels Since ACA Implementation

Hospital operating margins

Source: Merritt Research Services, LLC

The preliminary combined compilation of operating margins for both independent and system hospitals dipped to a barely positive level of .03 of 1%, which is headed for the worst showing since 2001.

Operating margin measures the profitability of operating revenues, meaning revenues generated organically through the provision of healthcare and related services. This is a good measure of fiscal sustainability, because it does not account for revenue from outside sources, be they public money, charitable donations, or other non-operating revenues. This chart demonstrates that the actual ‘business’ of hospitals has fallen steeply since the opening impact following the implementation of the ACA program for insurance coverage starting 2014.

State Opioid Death Rates: Analysis Indicates General Economic Conditions May Not be Determinative:
The opioid epidemic is possibly the most severe public health crisis in the United States, and it has afflicted the country at alarmingly increasing rates. By 2015, the highest opioid overdose death rates occur in states of which a large part is part of Appalachia, namely West Virginia, Kentucky, and Ohio. New England states are also particularly afflicted. West Virginia’s 2006 nation-leading death rate of 16.1 would only be the 11th highest state death rate in 2015.  Read more on the impacts and causes here.

 Policy Analysis – State Impacts of Medicaid Expansion Repeal:

Kaiser Uninsured Rates

This chart, created from a study by the Kaiser Family Foundation, shows uninsured rates for non-elderly persons between 2013-2016 were 2.2% greater in states that adopted the Medicaid expansion than those that did not. Other key policy implications of repeal:

In 2015, an estimated 11 million enrollees were adults made newly eligible by the expansion who could be at risk for losing Medicaid coverage.

Studies show states that Medicaid expansion states have experienced broader economic gains, like budget savings, increased employment, savings in other states programs, such as state-funded behavioral health or corrections, and increased hospital revenues.


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