Aug. 18—Hospitals in the 24 states that have not expanded Medicaid would lose $167.8 billion over a decade, according to a new analysis.

The analysis, backed by two pro-expansion organizations, calculated the hospital losses based on the lack of Medicaid coverage of 6.7 million uninsured residents of those states, who would otherwise qualify under the eligibility expansion of the Affordable Care Act (ACA).

The U.S. Supreme Court made the expansion optional for states in its 2012 ruling upholding the law. Most Republican-led states have refused the expansion.

Hospital payments would comprise much of the $423.6 billion in federal Medicaid funds that the states would receive between 2013 and 2022, according to the report. The lost hospital revenue would provide a 31 percent boost in Medicaid funding during that time. Meanwhile, the expansion would cost those states $31.6 billion over the decade.

The largest hospital revenue losses among states declining to expand would be in Texas ($34.3 billion), Florida ($22.6 billion), and Georgia ($12.8 billion), according to the analysis.

Hospital Cuts Underway

Many hospital organizations have led the Medicaid expansion push in their states, partially over a concern that without the additional revenue their finances would suffer from steep cuts required by the ACA.

Between 2013 and 2022, the ACA requires a $22 billion cut in Medicaid disproportionate share hospital (DSH) payments, a $34 billion cut in Medicare DSH payments, and a $260 billion cut in Medicare fee-for-service payments.

In response to concerns that Congress could cut the federal funding of the Medicaid expansion below 90 percent and leave states with large, unfunded costs, the authors noted that Congress has lowered the federal share of Medicaid spending only once since 1980. Meanwhile, it has cut Medicaid eligibility, services, and provider payments more than 100 times.

Publication Date: Monday, August 18, 2014