States that have accepted the Affordable Care Act (ACA) are positioned better financially than those states that rejected President Obmama’s Medicaid deal. Many states have medical institutions known as safety-net hospitals that provide care for uninsured patients. Harborview Medical Center in Seattle, Washington, accepted the Medicaid plan and has seen the number of uninsured patients drop 10 percent by the spring of this year. Harborview Medical Center’s revenue is expected to increase by $20 million this year. Without the Affordable Care Act, health care in Seattle would not be the same.
In Colorado, Denver Health cut their percentage of uninsured patients in half, and the University of Arkansas for Medical Sciences Hospital, in Little Rock, Ark., also had a decline of half of their patients without insurance. As two safety-net hospitals, they are financial beneficiaries of the expansion of this health law coverage. Safety-net hospitals treat a disproportionate amount of uninsured and poverty-stricken individuals in need of health care, approximately 13 million people.
Many such facilities were expecting a decline in patients who were uninsured, however, with the expanded Medicaid coverage in 25 states that occurred in January, the cuts have been deeper and faster than expected. Ellen Kugler, executive director of the National Association of Urban Hospitals, which represents safety-net institutions, based in Sterling Va., explained the ACA is working well in locations were it has been accepted.
Most safety-net hospitals are either nonprofit or government-owned institutions and regularly struggle financially, due to their urban locations. Many of their patients are uninsured, show up in emergency rooms and may not be turned away for treatment.
The 26 states and the District of Columbia that accepted the new Medicaid changes in the law saw enrollment in the new program increase by 17 percent, and for those states not enrolled there has only been a three percent increase. Many of the states that have refused the ACA are led by Republican governors and Republican legislatures. Hospitals in those states are beginning to feel the financial burden of opting out. Health care providers in states not accepting the Medicaid plan may face extreme financial challenges through this year and into the foreseeable future. Fitch Ratings, a credit rating company, reported these findings in a report dated July 16, 2014. Health care without the Affordable Care Act is affecting a disproportionate number of low income individuals and families across the United States.
Fitch Ratings has also downgraded 10 medical institutions, five are in states that did not participate in the Medicaid expansion coverage. Conversely, eight hospitals with an upgraded status are in states with expanded Medicaid coverage. Many of the downgrades were caused by declines in the hospitals’ financial performance and negative funding reimbursements (refusal to pay medical expenses).
While medical institutions in states accepting ACA are breathing sighs of relief and formerly uninsured children and families are now getting proper health care, states that have refused the medical plan have the opposite situation for many of their residents. In North Carolina, for example, nearly 500,000 residents who would have been eligible for ObamaCare, as the Affordable Care Act is sometimes referred to, now have no health care.
Many of the states refusing the ACA are Southern states, led by Republican governors with a philosophy opposing the Medicaid law. Those uninsured in these states are single mothers, more than 50 percent are low-wage workers and two-thirds are poor blacks. Medicaid expansion was rejected in North Carolina due to the cost of financing the program, according to Republican legislators and the Republican governor of the state, Pat McCrory. Health care in North Carolina’s present Medicaid program is rife with billing delays, and excessive costs, and needs adjustments without adding an Affordable Care Act, explained Rep. Nelson Dollar, vice chairman of the House Health and Human Services Committee.
By Andy Towle