Stark differences in hospital finances by state

The decisions by individual states to expand Medicaid eligibility under the Affordable Care Act (ACA) has created decidely different financial pressures on hospitals.

Hospitals and other organizations in the 27 states that expanded Medicaid, such as Washington, are moving to enroll those eligible into the program, PBS NewsHour reported. In the 23 states that did not expand eligibility, such as Virginia, there has been more of a struggle.

Washington's Apple Care Medicaid program has already reached its 2017 enrollment projections, primarily because the provider community could not afford to have those eligible for Medicaid unenrolled.

"It costs us all. It costs us in absenteeism at work. It costs us in days missed at school, and it just plain costs us on our healthcare bills. It is irrational. And the ACA presented us an opportunity to have a more rational system. And we took it," King County Executive Dow Constantine told PBS NewsHour. At Harborview Medical Center, Seattle's largest safety-net provider, the proportion of uninsured patients dropped from 14 percent to 4 percent. The University of Washington healthcare system projects its uncompensated care costs in 2014 will drop by $20 million to $30 million.

Nationwide, in states that expanded Medicaid eligibility, the number of uninsured that were admitted to hospitals dropped by 50 to 70 percent during the second quarter of 2014. Seventy-four percent of the estimated $5.7 billion reduction in uncompensated this year went to hospitals in states that expanded Medicaid eligibility, according to a recently released report by the U.S. Department of Health and Human Services.

Meanwhile, in non-expansion  states such as Virginia, Valley Health System had to cut jobs at its hospitals. It is also evaluating its specialty services.

"As these payment cuts continue to go, we have to evaluate, are these the types of programs, like the trauma, like behavioral health, that we can sustain?" Valley Health CEO Mark Merrill told PBS NewsHour. "There is a need for those services certainly here, but if the reimbursement doesn't justify the ability to sustain those, we have to evaluate whether or not we can continue these."

To learn more:
- read the PBSNewsHour transcript