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Safety Net Hospitals Face $53.3B in Uncompensated Care Costs by 2019

John Commins, for HealthLeaders Media, October 26, 2012

The U.S. Supreme Court ruling last summer that lets states opt out of Medicaid expansion under the Patient Protection and Affordable Care Act could saddle the nation's safety net hospitals with $53.3 billion in uncompensated care costs by 2019, according to the National Association of Public Hospitals and Health Systems.

"It's a projection based on [Congressional Budget Office] estimates of the additional number of uninsured as a result of the Supreme Court's decision," Beth Feldpush, vice president, policy and advocacy, at NAPH told HealthLeaders Media.

The June 28 landmark 5-4 ruling by the Supreme Court upheld key components of the PPACA,  including the individual mandate. However, the justices struck down as too coercive the law's attempts to get states to expand their Medicaid programs.

Feldpush says the high court's ruling skewed a balance in the law under which disproportionate share hospital payment cuts to safety net hospitals would be offset by expanded Medicaid coverage.

"Certainly the Supreme Court's decision changed the landscape. What was assumed to be Medicaid expansion in every state can't be assumed any longer," Feldpush says.

"When you think back to the assumptions that were made when the Affordable Care Act became law, at that time CBO said 'we expect 'X' number of people to get coverage and therefore the dollars in uncompensated care costs absorbed by hospitals will decrease.' The law was written with some sense of a balance between those two factors," she said.

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