By MARCIE SCHELLHAMMER

marcie@bradfordera.com

During the current Trump Administration, changes have been proposed or already put in place for many forms of health insurance, including Medicare, Medicaid and subsidized policies.

Some figures recently released by the Pennsylvania Health Care Cost Containment Council (PHC4) show who the insurance payers were in the third quarter of 2024 per county in the state. Statewide, Medicare was by the far the highest payer for 369,901 inpatient services, at more than double that of Medicaid, and 1.6 times higher than private commercial insurance. During the third quarter of 2024, Medicare covered 47.4% of cases in the state, while commercial insurance covered 28.9% and Medicaid covered 19.3%.

There were some selfpay cases, at 2%, and some other or unknown, at 2.5%, as well.

For 699,415 outpatient cases, Medicare and commercial insurance were closer in the percentage of cases covered, with Medicare highest at 44.8%, commercial insurance at 42.5% and Medicaid at 10%. There were .9% self-pay and 1.8% of other or unknown cases as well.

During that time frame, there were 1,311 outpatients using hospital outpatient departments and ambulatory surgery centers in McKean County.

How were those cases paid for? It’s a tie for the two largest payers, Medicare and commercial insurance each covered 39.1% of the patients. Medicaid covered 15.9%.

For the county’s 595 inpatient cases, Medicare paid for the most patients, at 49.7%, followed by commercial insurance at 30.9%, and Medicaid at 16.1%.

The results were similar in Elk County for 1,618 outpatients, with Medicare paying for 44.8%, commercial coverage for 40.7%, and Medicaid for 10.6%.

For inpatients, of which there were 842, Medicare paid for 50% of cases, while commercial insurance covered 31.8% and Medicaid covered 15%.

In Potter County, for outpatient coverage for 927 patients, Medicare and commercial insurance were closer in coverage than in the other counties. Medicare covered 43.7% of cases, while commercial insurance covered 39.5%. Medicaid covered 12.5% of cases.

The 332 inpatients were largely covered by Medicare as well, at 54.8%, while commercial insurance covered 27.7% and Medicaid covered 12.7%.

Cameron County was the only local one in which Medicaid covered more cases than commercial insurance did. For 121 inpatients, Medicare covered 46.3%, Medicaid covered 24.8% and commercial insurance covered 21.5%.

Outpatient coverage for 225 patients fell more in line with the rates in other counties. Medicare covered 53.8% of cases, commercial insurance covered 31.1% and Medicaid covered 12.9%.

PHC4 issues reports to provide a wealth of insight into healthcare.

Barry D. Buckingham, PHC4’s executive director, said, “Providing these quarterly County-Level Utilization Reports supports a consistent supply of fact-based data. These insights represent a vast range of facility data and are amongst the timeliest reports available to stakeholders.”

The reports are updated every quarter and show the number of cases for each county, with breakouts by patient age, sex and payer.

These quarterly reports portray the current climate of public health in Pennsylvania and provide focus and perspective. The County-Level Utilization Reports are valued resources for local communities, healthcare professionals and policymakers. By fostering a data-driven approach to healthcare, PHC4 envisions a healthier, more resilient society where resources are allocated effectively, and lives are improved.