The Affordable Care Act expanded Medicaid eligibility in the 26 states and the District of Columbia that chose to participate in 2014; the three states added in 2015; and two additional states in 2016.
A recent analysis 0f uncompensated care and operating margin data for 309 hospitals in participating states in 2014; 58 hospitals in states that first participated in 2015 or 2016; and 272 hospitals in non-participating states provided median data for each cohort between 2013 and 2015 and the first three quarters of 2016.
Medicaid expansion had a substantial impact on uncompensated care in participating states. Charity care began to decrease during the expansion year and continued to decrease the following year. Charity care remained almost the same in non-participating states. Bad debt also decreased slightly in participating states, but increased in non-participating states. Hospital operating margins improved in participating states and were maintained in non-participating states. Any Medicaid expansion replacement will have equally large effects.