The paper reports two key findings:
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Cost shifting from Medicare and MediCal is substantial. If, in 2005, the revenues for every California hospital's Medicare and MediCal patients would have been sufficient to cover these patients' costs, then private-payer patients' revenue-to-cost ratio would have declined by 10.8 percentage points, from 1.309 to 1.201.
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Cost shifting from the uninsured is minimal. If, in 2005, the revenues for every California hospital's indigent patients would have been sufficient to cover these patients' costs, then private-payer patients' revenue-to-cost ratio would have declined by 1.4 percentage points, from 1.309 to 1.295.
These findings have several implications for current policy debates. State health policy reforms that seek to cover the currently uninsured are unlikely to lead to significant reductions in private insurance premiums, at least due to decreases in cost shifting. In contrast, increases in public-program reimbursement rates could have an economically important impact on premiums.