Hospitals in states without Medicaid expansion face tough future

Missouri's hospitals--and their patients--are beginning to feel the bite of their state policymakers' decision not to expand Medicaid eligibility under the Affordable Care Act.

Missouri's decision not to expand Medicaid left nearly 200,000 state residents unable to obtain healthcare insurance, according to the Springfield News-Leader, As a result, the Missouri Hospital Association estimates a reduction of Medicaid payments by $700 million between now and 2019, along with another $3.3 billion in peripherally related cuts. MHA President Herb Kuhn noted that his membership has cut 1,000 jobs as a result. "We're really beginning to feel the pinch," he said.

Hospital executives throughout the state are concerned the cuts will also be extraordinarily hard for many of Missouri's rural facilities. "They were already under difficult challenges anyway," said Robert Steele, M.D., chief executive officer of Mercy Hospital in Springfield. At best, I believe that what you'll see is that hospitals have struggled so much that they get acquired by someone else."

Altogether, 25 states and the District of Columbia agreed to expand Medicaid eligibility under the ACA. Most of the remaining states are fairly adamant about not expanding, although some officials in Missouri believe the state's leadership will eventually relent.

Missouri is not alone in feeling a pinch. In Ohio, the Cleveland Clinic is expected to cut its budget by $330 million and offer early retirement to 3,000 employees. In the Southeast, the Carolinas Health System expects to lose up to $500 million in revenue over the next decade.

Virginia, which has also decided not to expand Medicaid for now, is expecting a shortfall of program payments that could total $7.4 billion over the next five years. One facility, the University of Virginia Medical Center, would stand to lose $40 million a year in payments alone, according to the Daily Progress.

"There is no plan B that I know of," Katharine M. Webb, a senior vice president with the Virginia Hospital Association, told the Daily Progress. "The plan B has to come from the people that are opposed to accepting the federal funds."

To learn more:
- read the News-Leader article
- here's the Daily Progress article

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