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The red-state/blue-state divide deepens on health care

It's not just the U.S. economy getting a boost from "Obamacare." Hospitals are benefiting, too -- at least in some states.
Empty hospital emergency room. (Stock photo by  DreamPictures/Getty Images)
Empty hospital emergency room.
It's simply taken as a given in conservative circles that the Affordable Care Act is awful for the economy, but increasingly, no one else seems to think so.
A Goldman Sachs researcher published a report for clients last week explaining that ACA subsidies bolstered the economy in the first quarter and will do the same this quarter. "While we were initially skeptical of the large estimated effect of the new subsidies on personal income, these now look more reasonable to us in light of revisions, greater enrollment than expected several months ago, and the fact that states are likely contributing to the subsidies on top of the well-known estimates of federal costs," the report said.
And it's not just consumers getting a boost. As Jason Millman reported, hospitals are benefiting, too -- at least in some states.

The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company 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 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.

Kevin Drum added, "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."
When we watch the debates unfold over Medicaid expansion, we expect to see folks like the uninsured, family advocates, religious leaders, and progressive activists pushing for conservative policymakers to do the right thing. For many Republicans, however, these aren't constituencies with meaningful political capital.
But state hospitals generally push just as hard in support of Medicaid expansion and this isn't a constituency GOP officials reflexively ignore.
In many Republican-led states, however, they're ignoring the hospitals' concerns anyway. Hating the president is, by all appearances, simply more important.
In Georgia, for example, Gov. Nathan Deal (R) has seen several rural hospitals close, in least in part because the state has rejected Medicaid expansion, which means uninsured patients won't become paying patients. The governor's response has been suggesting a possible change in the law, allowing hospitals to turn away patients with no coverage.