Health Care

Who pays hospital costs of gun violence? Depends on state’s Medicaid coverage

This 2013 photograph of a semi-automatic pistol and a revolver was taken at a gun buy back program held by the City of Miami police to reduce gun violence. A study published Friday found that who pays the hospital costs of gun violence can depend on a state’s Medicaid coverage for single adults.
This 2013 photograph of a semi-automatic pistol and a revolver was taken at a gun buy back program held by the City of Miami police to reduce gun violence. A study published Friday found that who pays the hospital costs of gun violence can depend on a state’s Medicaid coverage for single adults.

Who pays for the hospital costs of gun violence can depend on the state where the victim is hospitalized, according to a study published Friday by the nonprofit Urban Institute, a social policy think tank.

The study compared changes in coverage for the hospital costs of gun violence in six states — Arizona, Florida, Kentucky, New Jersey, North Carolina and Wisconsin — from 2010 to 2014.

In states that offer Medicaid coverage for single adults, who are among the most likely group to be hospitalized for gun violence, a larger share of the costs were paid by the public health insurance program for low-income and disabled persons, according to the study.

But in states, such as Florida, where legislators have refused to cover single adults with Medicaid, local taxpayers and privately insured patients paid a larger share of the costs.

Embry Howell, lead author of the study, said most uninsured patients are unable to pay the hospital bill for gunshot care, which in Florida averaged about $13,000 per patient in 2014.

But that doesn’t mean hospitals never get paid for uninsured patients, whose expenses are frequently referred to as uncompensated care.

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“Uncompensated care essentially gets passed on to the other patients as higher costs,” Howell said. “The hospital has to recover it somehow.”

Among the six states studied, Howell and co-author Anuj Gangopadhyaya found that hospitals in Kentucky saw the greatest change in coverage for costs of gun violence.

Of the roughly $3.1 million that Kentucky hospitals spent in 2010 caring for gunshot victims, about 54 percent was for uninsured patients, according to the study. In 2014, the year Kentucky expanded Medicaid, the share of statewide hospital costs for uninsured patients with gunshot wounds was about 12 percent.

Over the same period, Florida hospitals saw a decline in the costs of gun violence — from $30 million in 2010, to $28 million in 2014. But the share of hospital costs for uninsured patients remained unchanged at 31 percent.

Had Florida expanded Medicaid coverage to single adults as provided for in the Affordable Care Act, Howell said, the state’s hospitals likely would have received more payments for caring for victims of gun violence, reducing their need to shift the costs of uncompensated care to local taxpayers and privately insured patients.

“It’s the local communities that are impacted, basically,” she said.

The latest study updates a 2013 report on the financial costs of gun violence, which found that in 2010, national costs totaled nearly $670 million — most of which is paid for by the public, either through public insurance programs like Medicaid or through taxpayer subsidy of uncompensated care.

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Daniel Chang: 305-376-2012, @dchangmiami

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