Gun injuries cost the US more than $6 billion over 9 years

Most of those struck by a bullet end up in the hospital (81,000 people were hospitalized with gun-related injuries in 2014).

If you're one of those people, that injury likely brings pain and a good deal of stress. There's also a risk of disability, trauma, and further treatment required down the line.

But gun-related injuries also come with significant financial costs, both for the victim and society overall. Like most other public health issues in the United States, gun violence is an insurance cost problem.

States with the toughest gun laws

26 PHOTOS
States with the toughest gun laws
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States with the toughest gun laws
National Rifle Association's (NRA) annual meetings and exhibits show in Louisville, Kentucky, May 21, 2016. (Reuters)

#24. West Virginia
Score: 
18
Grade: D- 

West Virginia may rank low in terms of overall gun control, but in 2015 Democratic Gov. Earl Ray Tomblin vetoed a bill that would have allowed people to carry concealed weapons without a permit.

#23. Indiana
Score:
 19.5
Grade: D-

The relatively lax firearm laws in Indiana have led some to link them to gun violence in Chicago.

#22. New Hampshire
Score: 
20.5
Grade: D

New Hampshire requires handgun dealers to obtain a state license, but does not extend the rule to dealers of rifles and shotguns.

#21. Nebraska
Score: 
21.5
Grade: D

Nebraska differs from many states in that it gives local jurisdictions some control over firearm regulations.

#20. Virginia
Score: 
22
Grade: D

Following the Virginia Tech shooting in 2007, the state took greater measures to report mental health records and prohibit sales of firearms to any person who has been "adjudicated as a mental defective."

#19. Ohio
Score: 
24
Grade: D

Ohio does not prohibit the sale of assault weapons nor limit the number of firearms that may be purchased at one time.

#18. Wisconsin
Score: 
25
Grade: D

In a major blow to gun control advocates, Republican Gov. Scott Walker repealedthe state's mandatory 48-hour waiting period for handgun purchases in 2015.

#17. Iowa
Score: 
29
Grade: C-

Iowa took steps to tighten gun control when it enacted child access preventionrequirements upon gun owners.

#16. Colorado
Score: 
29.5
Grade: C-

While Colorado requires licensed firearms dealers to process background checks, it does not impose limits on the number of firearms that may be purchased at one time.

#15. Michigan
Score: 
30
Grade: C

Michigan gun control laws require firearm owners to report handgun purchases and theft of any firearm.

#14. Oregon
Score: 
31
Grade: C

Oregon greatly strengthened its firearm regulations in 2015 when it enacted laws requiring background checks for all firearm purchases.

#13. Pennsylvania
Score: 
35
Grade: C

Compared to other solidly Democratic states, Pennsylvania's gun control laws are relatively lax, with no requirements for firearm owners to obtain licenses or register their weapons.

#12. Minnesota
Score: 
36.5
Grade: C

Although federally licensed firearms dealers must initiate background checks, Minnesota does not require private sellers to do so.

#11. Washington
Score: 
47.5
Grade: B-

Washington requires all firearm dealers to obtain a state license, but does not mandate that individuals register their weapons.

#10. Delaware
Score: 
50.5
Grade: B

Delaware has relatively strict gun control measures, including mandatory background checks and purchase restrictions on domestic violence misdemeanants.

#9. Rhode Island
Score: 
58.5
Grade: B+

Rhode Island may have comprehensive gun control measures overall, but it stilldoes not prohibit the transfer or possession of assault weapons.

#8. Illinois
Score: 
60
Grade: B+

In addition to requiring background checks, Illinois has instituted some design safety standards for handguns.

#7. Hawaii
Score: 
73.5
Grade: B+

In 2014, Hawaii had the lowest number of firearm-related deaths per 100K people. Gun regulation advocates have attributed this to its tight gun control measures.

#6. New York
Score: 
81
Grade: A-

New York enacted major gun control reforms in 2013, including an expansion of the assault weapons ban and requirements for ammunition dealers to conduct background checks.

#5. Massachusetts
Score: 
81.5
Grade: A-

Following the New York reforms, Massachusetts passed a comprehensive gun control bill in 2014 that increased firearm regulations.

#4. Maryland
Score: 
82
Grade: A-

Among Maryland's firearm regulations are a ban on the transfer of certain assault weapons and a mandatory seven-day waiting period prior to the physical transfer of a firearm.

#3. New Jersey
Score: 
86
Grade: A-

Republican Gov. Chris Christie may have shifted to the right on the issue of gun control, but his state still has some of the tightest firearm regulations in the country.

#2. Connecticut
Score: 
86.5
Grade: A-

Connecticut's extensive gun control laws require firearms dealers to obtain a license and mandate background checks for all firearm sales at gun shows.

#1. California
Score: 
93.5
Grade: A-

California takes the top spot as the state with the strictest gun control measures. Among the regulations in place are required background checks and limitations on the number of handguns an individual can purchase each month.

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A new study, published March 21 in the American Journal of Public Health (AJPH), found that between 2006 and 2014, hospitalizations due to firearm injuries cost the US $6.61 billion — an average of $734.1 million per year.

The cost of gun violence impacts various populations differently

Private insurance paid for $21.4% of that total cost, and individual patients took care of another $29.4%.

Government insurance — Medicare and Medicaid — paid for 40.8% of it ($2.70 billion), with most of that ($2.30 billion) coming from Medicaid, which covers 74 million people with low incomes.

Just over 63% of Medicaid patients who end up in the hospital due to firearm injury are assault victims, with only 4.6% of them hospitalized for self-inflicted wounds.

SEE ALSO: Drug shortage in 2011 tied to increased deaths

Medicare patients — a wealthier group of 57 million people that includes seniors and people with disabilities — accounted for just under $400 million in gun violence expenses. And there was another notable difference between the two groups: Just 26.1% of Medicare patients that ended up in the hospital with a gunshot wound were assault victims, while 27.7% suffered self-inflicted injuries.

The researchers suggest those disparities come down to some basic differences between the two populations.

Medicaid patients are younger and poorer, and statistically more likely to become victims of gun violence committed by other people. Medicare patients are older and wealthier, and more likely to be victims of self-inflicted wounds — a form of gun violence that's actually more common than homicide.

Because you're more likely to make it to a hospital if someone else shot you than if you shot yourself, Medicaid patients make up a larger portion of the healthcare costs.

Paying for uninsured gun violence victims

The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, which was the source for most of the data in the AJPH paper, counts nearly $1 billion in healthcare costs as paid for by "other" sources.

That means hospitals are absorbing the costs themselves (primarily teaching hospitals in big cities, which have the most resources and see the most gun violence patients). But the authors point out that the buck doesn't really stop with Mt. Sinai, Johns Hopkins, or any other big hospital system. If those institutions had to shoulder the costs of thousands of gunshot victims, they'd likely collapse.

Instead, those unpaid treatments get written off as losses, which means federal and state governments end up funding them through block grants and backdoors in the tax code.

Uninsured gunshot victims benefit, in other words, from a very inefficient form of government-subsidized healthcare, which only kicks in after dire emergencies.

The full picture is bigger than $6.61 billion

The numbers in this study, big as they are, represent just a fraction of the total strain gun violence puts on the American healthcare system.

As the authors write, that $6.61 billion in expenses only accounts for initial admissions and treatments — the costs of patients who turn up at the hospital after getting shot.

But there's a whole set of medical expenses that go beyond that emergency, day-one treatment.

Patients might have follow-up surgeries to fix problems not addressed when they were first treated in the emergency room. They might need physical therapy to gain back a range of motion, or a home healthcare worker to help with basic tasks if they've suffered a crippling injury.

None of those costs turn up in this research. So $734.1 million per year is just the beginning.

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