A look back on healthcare finance in 2014

The year 2014 was one of the more historic in terms of healthcare finance. Millions of Americans gained health insurance coverage through new health insurance exchanges under the Affordable Care Act (ACA), as well as the expansion of Medicaid eligibility. But it was also a year of anxiety for healthcare and hospitals as a new disease entered the United States for the first time.

Under the ACA, some 7.3 million Americans purchased insurance through the exchanges during 2013 and early 2014 that provided them coverage during the last calendar year, and the vast majority--85 percent--qualified for some form of tax subsidies to pay their premiums.

The new insurance expansion had several impacts on hospitals. Emergency room visits at hospitals will likely continue to grow at a tremendous clip, according to the Centers for Disease Control and Prevention. But the Department of Health and Human Services reports that hospitals will also see what they pay for uncompensated care drop by as much as $5.7 billion during 2014. However, there is a split, with a large majority of the hospitals reaping that largesse in states that expanded Medicaid eligibility.

Some states that had refused to expand Medicaid in the past, such as Pennsylvania, acquiesced and began bringing in enrollees under ACA guidelines in late 2014. Several other states, such as Alabama and Alaska, are now seriously considering their expansion options, although resistance from some Republican lawmakers will likely remain high. It is expected that this will only continue to help the bottom lines of hospitals in those states, as their uncompensated care costs continue to drop.

In 2014, hospitals also learned how much it cost to treat an Ebola patient: As much as $50,000 per day. In some cases, it was not only the cost of providing such intensive care to the patients while safeguarding other patients and staff from contracting the Ebola virus, but also the harm to a hospital's reputation that seeped into the bottom line. Texas Health Presbyterian, which failed to fully contain the Ebola virus at its Dallas facility and had two nurses come down with the virus, faced a huge temporary drop in both revenues and hospital census.

To learn more:
- read the HHS statement on uncompensated care

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