Insurance expansions and hospital utilization: Relabeling and reabling?

The 2010 Patient Protection & Affordable Care Act (ACA) significantly expanded access to private and public health insurance for low-income individuals through income-based subsidies and income-based eligibility expansions, respectively. In this paper, we use the universe of hospitals from 2009 to 2015 to characterize how these expansions affected the financing of hospital visits, along with price, utilization, and potential spillovers in the quality of care. The insurance coverage expansions generated a shift in the composition of payers and a modest increase in the utilization of hospital outpatient services. While concerns have been raised that these shifts in utilization could cause negative spillovers to the already insured population (e.g., Medicare enrollees), we find no significant change in the quality of care experienced by those already insured. The primary result of both federally funded insurance expansions was to increase the profits generated and prices charged by the hospitals providing such services.