Showing a united front, the nation's largest hospital associations roundly condemned of the DOJ's decision to abandon its defense of the ACA.
The decision this week by the Department of Justice to drop any and all defense of the Affordable Care Act was met with scorn and dismay from the nation's hospital lobby.
American Hospital Association President and CEO Rick Pollack called the DOJ's about-face on the ACA defense "unprecedented and unsupported by the laws or the facts."
"America's hospitals and health systems oppose the Department of Justice's misguided decision calling on the courts to strike down the Affordable Care Act in its entirety," Pollack said in a media release.
"If courts were to adopt the DOJ position, Medicaid expansion would be reversed and protections for people with chronic and pre-existing conditions would cease to exist," Pollack said. "Millions of Americans would lose the coverage they have relied on for years. We have made too much progress in coverage and access to care for patients to go backwards."
The DOJ had argued in District Court proceedings last fall that most of the sprawling healthcare legislation should remain intact, even if the ACA's individual mandate were to be struck down in light of Congress zeroing out its tax penalty. Only the ACA's community-rating and guaranteed-issue provisions—which protect consumers with preexisting conditions—should fall with the mandate, the DOJ had argued.
District Judge Reed O'Connor's decision last December went much further than the DOJ had urged, declaring the entire ACA invalid, as the Texas-led coalition of plaintiff states had requested.
Now that an appeal is pending at the Fifth Circuit, however, the DOJ has decided that it agrees with the plaintiffs' argument and O'Connor's decision after all.
Federation of American Hospitals President and CEO Chip Kahn called the reversal "unfortunate but not unexpected considering (the Trump administration's) long-held views on the health law."
"Millions of Americans depend on the ACA to access healthcare and rely on the insurance protections afforded in the law," Kahnsaid. "We continue to believe the district court judge got it wrong and trust that this decision will be overturned in the appeals process."
Beth Feldpush, senior vice president of policy and advocacy at America's Essential Hospitals, called the Trump administration's position "untenable for our hospitals and their patients."
"It threatens to reverse important gains in health and healthcare access and take us back to a time when the emergency department was the only option for millions of people," Feldpush said. "That’s unsustainable and would push our hospitals to the breaking point as they struggle with the swelling costs of uncompensated care."
Sister Carol Keehan, DC, president and CEO of the Catholic Health Association of the United States, called the reversal "unconscionable and immoral."
"The Department of Justice, now backtracking from its prior legal stance to argue instead that the entire Affordable Care Act should be struck down, is stunning," Keehan said. "The time has come for our government to stop playing politics with people's health and livelihoods."
Keehan said the elimination of the ACA would bring back a litany of healthcare access and coverage problems that preceded the sweeping legislation, including the loss of guaranteed protections for 130 million people with pre-existing conditions and the elimination of Medicaid coverage for 17 million poor people.
"We would return to the era of insurance companies defining what they cover rather than being required to offer plans that provide true health security," she said. "The continuing innovation to shift the healthcare system toward providing more affordable and quality health care to people in this country would also be lost."
Keehan said the CHA would be filing a friend-of-the-court brief " to alert the Fifth Circuit to the dire consequences of upholding the District court's decision."
"If the last few years of debating the Affordable Care Act and all its provisions have taught us anything, it is that Americans value their healthcare," Keehan said.
The suit alleges that specialists at Wheeling Hospital were paid exorbitant salaries of more than $1 million per year because their referrals generated downstream revenue for the hospital.
Federal prosecutors have taken up a whistleblower lawsuit alleging that a West Virginia hospital, its management company, and CEO paid illegal kickbacks to physicians for patient referrals.
The Department of Justice alleges that nonprofit Wheeling Hospital Inc., violated the Stark Law and Anti-Kickback Statute, and that those violations were caused by R & V Associates Ltd., Wheeling's contracted management consultant, and Wheeling CEO Ronald Violi, who prosecutors allege had "dictatorial control" of the compensation agreements.
According to the suit, the 247-bed Wheeling Hospital had lost $50 million in the seven years before Violi and R&V took over management in 2005.
The managers quickly turned the hospital "into an extremely profitable venture. However, several of the arrangements that drove this newfound excessive profitability were illegal."
"Wheeling Hospital's dramatic revenue increase was accomplished by entering into lucrative but improper compensation arrangements with physicians that were well above fair market value, took into account the value or volume of services and/or were not commercially reasonable, in order to gain the physicians' referrals," the suit claims.
Prosecutors said that OB/GYNs, cardiologists, radiation oncologists and other specialists were overpaid exorbitant salaries—in some cases more than $1 million per year—because their referrals generated downstream revenue for the hospital.
Ultimately, some of those downstream revenues were reimbursed by Medicare or Medicaid.
The suit was filed in U.S. District Court for the Western District of Pennsylvania.
"Improper financial arrangements between hospitals and physicians can influence the type and amount of healthcare that is provided," said Assistant Attorney General Jody Hunt of the Department of Justice's Civil Division.
"The Department is committed to taking action to eliminate improper inducements that can corrupt the integrity of physician decision-making and drive up healthcare costs," he said.
The complaint is contained in a lawsuit filed under the whistleblower provisions of the False Claims Act that authorize private parties to sue on behalf of the federal government for false claims and share in any recovery. The whistleblower, Louis Longo, was an executive vice president at the hospital from 2011 to 2015.
The law permits the federal government to intervene and take over the lawsuit, as it did here in part.
Wheeling Hospital Responds
A Wheeling Hospital executive called the DOJ's suit an "unwarranted attack on what the hospital stands for and the ethics by which it operates."
"As we have said before, the allegations in this lawsuit are simply not true and an unfair attack on our hospital, our values and our dedicated physicians who partner with us to provide care to our community," said Gregg Warren, the hospital's vice president of marketing and public relations.
"We stand by our physicians and will aggressively defend against these baseless and unsubstantiated claims, while remaining fully committed to providing world-class care to the citizens of Wheeling and the Upper Ohio Valley every day," he said.
"We are particularly disappointed that the U.S. government chose to file its claims against our hospital in Pennsylvania rather than in Wheeling," Warren said. "Our community, our employees and loyal patients deserve to have the case litigated in West Virginia, where our hospital is located and our physicians provide care."
MedStar Health and two affiliates allegedly paid kickbacks to a cardiovascular surgeons group under the guise of professional services agreements.
MedStar Health Inc. and two affiliate hospitals will pay the federal government $35 million to resolve whistleblower allegations that the health system paid illegal kickbacks to a cardiology group in exchange for patient referrals, the Department of Justice said.
"Kickbacks give doctors an incentive to pursue unnecessary treatments that are costly and sometimes even dangerous to patients," Robert K. Hur, U.S. Attorney Robert for the District of Maryland.
"We will not tolerate medical care providers who put their patients at risk and waste taxpayers' dollars in order to line their own pockets," Hur said.
According to federal prosecutors, between 2006 and 2011 Columbia, Maryland-based MedStar Health, and Baltimore-based affiliates MedStar Union Memorial Hospital and MedStar Franklin Square Medical Center allegedly paid kickbacks to MidAtlantic Cardiovascular Associates under the guise of professional services agreements.
MedStar also agreed to settle allegations that it received Medicare payments from Jan. 1, 2006, through Dec. 28, 2012, for medically unnecessary stents performed by John Wang, MD, a one-time employee of MACVA who was later employed by MedStar.
The settlement resolves a lawsuit brought by three whistleblowers physicians: Stephen D. Lincoln, MD; Peter Horneffer, MD; and Garth McDonald, MD, cardiac surgeons who practiced together as members of Cardiac Surgery Associates in Baltimore.
The settlement also resolves a lawsuit brought by former patients of Wang, who claimed that Wang, MedStar, and Union Memorial knowingly performed medically unnecessary percutaneous transluminal coronary angioplasty with stent placement procedures and submitted false claims to Medicare for those cardiac stent procedures.
Under the civil settlement, the whistleblowers will receive a portion of the federal share of the recovery.
MedStar Health Responds
MedStar Health issued a statement noting that it denied "all wrongdoing."
"We fully cooperated with the government's investigation of these matters and ultimately determined that it was best to settle these matters in order to avoid protracted and distracting litigation," MedStar said.
"Importantly, the two cases have been settled without any findings of liability. MedStar has full confidence in our quality assurance and compliance programs, and we remain fully focused on advancing our patient care mission."
But a new study shows people living in areas with only one or two plans pay significantly more for premiums than do people in more-competitive regions.
The Affordable Care Act's Marketplace plans got more competitive in 2019, but there are still more regions with only one or two plans to pick from, a new study suggests.
The number of people living in areas with five or more marketplace insurers increased by 8% in 2019, from 18.6% to 20.1%, according to the analysis by the Urban Institute and the Robert Wood Johnson Foundation.
At the same time, the analysis showed that the number of people living in areas with only one or two plans in 2019 dropped by 17%, from 45.1% to 37.5%, which the report said signals an increase in marketplace competition between 2018 and 2019.
However, the study found wide swings in plan availability depending upon geography.
More than 20% of Americans live in an area with five or more marketplace insurers, the 322 least competitive rating regions are disproportionately concentrated in less populated areas of the country, especially the South.
"It's encouraging to see signs of stabilization in the individual market," said Anne F. Weiss, managing director at the Robert Wood Johnson Foundation, in comments accompanying the study.
"However, geographic location still plays too great a role in consumers' coverage options and how much they cost. Everyone should have affordable health insurance options, regardless of where they live, given the impact of coverage on health," Weiss said.
Among the findings:
The Northeast leads the nation in marketplace insurer competition, with a little more than 40% of its population living in areas with five or more marketplace insurers.
In the South, only 4% of residents live in areas with five or more marketplace insurers, while a majority (just under 53%) live in areas with only one or two marketplace insurers.
Approximately 26% of the population in both the West and the Midwest live in areas with five or more insurers, with 19% and 40% living in areas with only one or two insurers, respectively.
Consumers in areas with fewer marketplace insurers typically pay higher premiums. In 2019, the median benchmark silver plan premium for a 40-year-old non-smoker in regions with one insurer cost $592 per month compared to $376 per month in regions with five or more insurers, a difference of more than 36%.
GAO Study Sees Market Concentration
A separate study issued this month by the Government Accountability Office found that enrollment in private health insurance plans continued to be concentrated among a small number of health insurers in 2015 and 2016.
In the large group market, small group market, and individual market, the three largest commercial health insurance plans held 80% of the market or more in at least 37 of 51 states. The findings are similar to what GAO reported for 2011 through 2014.
GAO also found that within the overall individual and small group markets in each state, the health insurance exchanges established by the ACA were also concentrated from 2015 to 2017.
For the individual market exchanges, in each year, three or fewer issuers held 80% or more of the market, on average, in at least 46 of the 49 state exchanges.
The largest insurers increased their market share in about two-thirds of exchanges.
For the small group market exchanges, in each year, three or fewer issuers held 80% or more of the market in at least 42 of 46 state exchanges.
Tersigni, who has led the St. Louis-based Catholic health system for 15 years, will depart at the end of the year. The search is underway for his successor.
Long-serving Ascension CEO Anthony R. Tersigniwill retire at the end of 2019, and the search is on for his replacement, the St. Louis-based Catholic health system announced Thursday.
"Tony has informed the Board that he intends to retire on December 31, 2019, after leading Ascension for more than 15 years," Ascension Board Chairman Stephen M. Dufilho said in a message posted on the health system's website.
"He will continue to serve Ascension as a member of the executive committee of Ascension's healthcare investment fund and will provide consultative services to Ascension on an ongoing basis. The Board has begun a formal process to evaluate and select a successor to Tony," Dufilho said.
Tersigni was named president and CEO of Ascension Health in 2004, after serving briefly as the interim leader of the health system, and before that as COO since 2001.
When Ascension was formed in 2012 as the parent organization of Ascension Health and its other subsidiaries, Tersigni became its first president and CEO.
"A vibrant servant leader, Tony has shepherded Ascension through a period of unprecedented change in the U.S. healthcare industry while remaining true to the vision and legacy of the founding religious congregations of Ascension," Dufilho said.
Tersigni was a driving force behind the health system's One Ascension initiative, which aligned and improved operational structures to improve consistency and efficiency, Dufilho said.
"As the healthcare landscape continued to rapidly change, Tony led the effort to review and update Ascension's Strategic Direction as a strategic framework to best position the health ministry for the future," Dufilho said.
"Tony championed the idea that we must pursue a Dual Transformation model, optimizing and transforming our core healthcare operations while creating transformational new models that extend our reach and provide the engine for growing our ministry and its impact," Dufilho said.
Tersigni is the fourth senior leader at Ascension to announce their departure this year.
Patricia A. Maryland announced in January that she would leave Ascension Healthcare after serving in various roles for 15 years, effective July 1.
Similarly, John D. Doyle, Ascension's executive vice president, and David B. Pryor, MD, Ascension's CCO, will retire on June 30, the end of the company's fiscal year.
Ascension is one of the largest Catholic health systems in the nation, with 151 hospitals, more than 50 senior care facilities, 2,600 care sites, 156,000 employees and 34,000 providers operating in 21 states and the District of Columbia.
A study found that 37% of patients who took warfarin also took aspirin. That could place patients at a significantly higher risk of adverse outcomes, including major bleeding events.
Physicians who've prescribed anticoagulants to their patients should double-check to make sure they're not using aspirin too, a new study out of Michigan Medicine suggests.
The study, published this month in JAMA Internal Medicine, found that 37.5% of the 6,539 patients reviewed were receiving the anticoagulant warfarin and aspirin without a clear indication, and that these patients were at a significant increase in adverse outcomes.
"Nearly 2,500 patients who were prescribed warfarin were taking aspirin without any clear reason, over a seven-year period," said senior author Geoffrey Barnes, MD, a vascular cardiologist and an assistant professor of internal medicine at U-M Medical School. "No doctors really own the prescribing of aspirin, so it's possible it got overlooked."
The study cohort included 6,539 patients who were enrolled at six anticoagulation clinics in Michigan between 2010 and 2017.
In this study, 5.7% of those using aspirin and warfarin experienced major bleeding events after one year, compared to 3.3% of those on warfarin only. The combination group that was using aspirin without a clear indication also visited the emergency department and/or were hospitalized for bleeding significantly more often.
There wasn't a difference in stroke or heart attack outcomes that are typical uses for aspirin, Barnes says. The mortality rates at one year were similar between both groups, and 2.3% of those on both medications had a thrombotic event at one year compared to 2.7% of those on warfarin alone.
Barnes spoke with HealthLeaders about the findings. The following is an edited transcript.
HLM: More than one-third of patients were taking both aspirin and warfarin. Why is that percentage so high?
Barnes: You're seeing here is a two factors. First is, unlike many randomized trials, we included all patients who were managed in our anticoagulation clinics. So we were not filtering out only the healthy patients are only those who did not have risk of bleeding. You get a broader perspective of what kind of risk patients are at when you follow them over the long term. This was a practice-based, real-world cohort as opposed to a randomized trial cohort.
Secondly, we've known from various is other studies that the more blood thinners you take, the higher your risk of bleeding. When these patients are taking both aspirin and warfarin together, that's going to increase their overall risk of bleeding.
HLM: If they didn't consult with a physician, what made these patients think it was a good idea to take both medications?
Barnes: We don't know exactly why they were taking aspirin. However, there are a couple potential scenarios. The first is that this is somebody who maybe was on aspirin for primary prevention and then developed Afib or DVT and so was started on warfarin, but nobody thought to stop aspirin.
Another scenario is they were on warfarin for Afib and they read or heard something that said, 'you should take aspirin to help prevent a heart attack.' That's out there in the in the media quite a bit. And so they said, 'Oh, well, it's just over the counter. It's got to be safe.' So they go ahead and take it.
The third is that maybe they had a good reason to be on aspirin. Maybe they had a coronary stent that was placed or something, and so they were on aspirin. As time went on, that coronary stent was no longer recent, no longer fresh, and so the indication for aspirin is not quite as strong and yet nobody bothered to think about stopping aspirin.
HLM: Is this something that should be addressed on the patient level, or is this a health systemwide issue that requires new protocols?
Barnes: It's actually both. The first thing we know is that aspirin is a really difficult drug to study and understand because it's not prescribed. Many clinicians do not know whether their patients are taking aspirin or not, because they're not routinely examining their medical record.
Secondly, we as healthcare providers don't always do a great job reconciling the medication list. Even though patients are coming into clinic are coming in for procedures, we don't do a great job making sure we know which drugs they are taking, or they're not taking. Right off the bat, there are some challenges to even knowing when the situation exists.
Systematically there are opportunities for us to build in a screen so you could run a report of all your patients who are on multiple antibiotics, and then cross reference that with sort of those who have indications like heart valve replacement, or recent stent placement or something, and those who don't.
In our situation, we have these big robust anticoagulation clinics. We've put in place a process where we will screen anyone who's on aspirin at the time to start warfarin and say 'is it really necessary?'
Of course, it always comes down to the individual patient level. You have to make a personalized decision. Some are going to be clear cut. Others may be more questionable.
What do you do if somebody had a coronary stent a year or two ago? Should they be an aspirin or not? These are questions that we have to ask other specialists then make the best decision for each individual patient.
A national study of more than 5,000 physicians indicates that most are generally happy and have high life satisfaction.
A new study commissioned by the American Academy of Family Physicians finds that most physicians are happy with their careers and personal lives.
Despite the spate of alarming headlines about physician burnout, a surveyof more than 5,000 physicians currently practicing found that 71% reported being happy in their professional lives, and 59% said they were satisfied with their lives in general.
"Practicing medicine is a profoundly rewarding profession," said Clif Knight, MD, senior vice president of education for AAFP.
"As with any job, it's important to find meaningful work-life integration," Knight said. "The AAFP has developed resources to help improve physician well-being while we are simultaneously fighting to reduce administrative burden, one of the key factors physicians cite as a barrier to happiness at work."
The survey, compiled with the healthcare staffing firm CompHealth, found that workplace happiness "is grounded in developing positive relationships with family members, friends, coworkers and patients."
"Physician burnout is a real issue that has dominated the industry for a lot of years. With this survey we wanted to take a deeper look at what drives workplace happiness, and why," said Lisa Grabl, president of CompHealth.
"We found that many physicians still take great joy in the practice of medicine and discovered areas where administrators and physicians alike can work together to further increase physician happiness," she said.
The survey found that:
Relationships matter. Physicians with a lot of friends at work reported high life satisfaction, while physicians with no friends at work only had 39% report they had high life satisfaction.
Lack of control and excess paperwork make physicians unhappy. Work issues such as lack of control (72%), clerical burdens (71%) and emotional exhaustion (69%) detracted from medical providers’ happiness. Specific tasks such as administrative duties (28%) also limited workplace happiness.
Lack of time with patients may be another contributing factor for physician unhappiness. Fifty-five percent of physicians reported time available for individual patients has declined since they started practice. However, 44% reported that quality of patient care had improved since they began practice.
CHI Franciscan has confirmed that the case has been settled, but few details have been made public.
Washington state has settled a price fixing suit involving CHI Franciscan Health and two physician practices in the Tacoma area, the Kitsap Sun reported.
Details of the settlement are scarce. Washington Attorney General Bob Ferguson's office did not return queries Wednesday, but the settlement was confirmed by a spokeswoman for CHI Franciscan.
The trial was scheduled to begin this week in U.S. District Court in Tacoma. The two sides were ordered to file dismissal paperwork by the end of April.
Cary Evans, vice president of communications & government affairs at CHI Franciscan, said that "along with the court's recent judgment to remove WestSound Orthopaedics from the lawsuit, the settlement ensures CHI Franciscan's joint affiliations with WestSound and The Doctors Clinic remain in place."
"This is good for patients and doctors on the Peninsula, keeps our highly skilled doctors in our community, and ensures everyone has access to great care close to home," Evans said.
Ferguson filed suit against CHI Franciscan, The Doctors Clinic and WestSound Orthopaedics in August 2017, to undo what he said were two unlawful agreements that raised prices and decreased competition for healthcare on the Kitsap Peninsula.
"These transactions were intentionally made to decrease competition, increase prices, and pad CHI Franciscan's bottom line at the expense of its patients," Ferguson said at the time, alleging that CHI Franciscan has netted well over $1 million in ill-gotten gains.
CHI Franciscan WestSound Orthopaedics, a practice of seven orthopedic physicians based in Silverdale in July 2016. Two months later, CHI Franciscan announced an affiliation with The Doctors Clinic, a multi-specialty practice with more than 50 physicians, which has seven locations in Kitsap County.
In the lawsuit, the state alleged that both transactions violated state and federal antitrust laws.
However, CHI Franciscan denied the allegations, and said the physicians' groups were financially distressed and acted independently when they proposed the affiliations, and that they had attempted unsuccessfully to work with Ferguson's office to find a solution.
"We are very concerned that the AG’s actions will drive away physicians from the community, inhibit our ability to recruit new physicians to the area, and will ultimately result in fewer choices and less quality healthcare available to the residents of the community," CHI Francisican said in prepared remarks.
Cigna claims that it's owed around $16 billion as the injured party in the deal, while Anthem says it's owed $20 billion after Cigna intentionally scuttled the deal.
Feuding Cigna Corp. and Anthem Inc. are waiting for a chancery court judge in Delaware to decide which of the two health insurance giants is owed billions of dollars in compensation after 2017's collapsed merger bid,CT Mirrorreports.
In a trial that began Feb. 25, Cignatold Delaware Chancery Judge Travis Laster that it's owed around $16 billion as the injured party in the deal, while Anthemsays it's owed $20 billion after Cigna intentionally scuttled the deal.
Although Cigna shareholders were expected to collect a 30% premium with the merger, Anthem alleged that Cigna CEO David Cordani sabotaged the deal because he would have had a reduced role as COO in the newly merged company, which would be led by Anthem CEO Joe Swedish, Bloomberg reported.
Anthem announced plans to acquire Cigna in 2015 for $49 billion in cash and stock, which if finalized would have created the largest health insurance company in the nation. However, the merger collapsed in 2017 after the Department of Justice successfully sued to block the deal after raising antitrust concerns.
The collapsed merger talks, suit, and countersuit exposed bitter fighting among top executives at both companies.
During the DOJ antitrust trial in late 2016, transcripts obtained by The Wall Street Journal revealed details about the continuing antagonism between Anthem and Cigna's top executives.
Cordani confirmed to the court that Cigna had stopped participating in some merger activities, saying he worried that Anthem's integration strategy could damage Cigna's network and value, the Journal reported.
Swedish testified that when Cigna stopped cooperating with the merger plan, Anthem created a confidential team to complete the task without Cigna's knowledge, according to the documents.
DOJ attorneys expressed concern that the rift could cause the merger to fall apart even if the court allowed the plans to proceed, and that such a failure could harm both companies' customers.
That prompted the U.S. District Judge Amy Berman to question the insurers' promises of a smooth consolidation. "How do you work on integration without talking to the person you're integrating with?" Jackson asked.
Work requirements could shrink Medicaid rolls and increase uncompensated care costs for hospitals in states that implement them.
Hospitals in 15 states could take a financial hit from shrinking Medicaid rolls if work requirements are mandated for beneficiaries, a new Commonwealth Fund study shows.
However, the design of states' work requirement programs will play a key role in how many beneficiaries lose coverage and the resulting financial hit for hospitals, the study found.
Under most work requirement mandates, Medicaid beneficiaries lose health insurance coverage if they cannot find work, are unable to document the required number of hours of work activity, or cannot document an exemption.
The Commonwealth Fund study estimates that Medicaid work requirements could contribute to an increase in uncompensated care costs for all hospitals across 15 states that have implemented the mandates, or hope to, totaling between $2.5 billion to $3.7 billion in 2019.
Those financial woes could trickle through the communities these hospitals serve in the form of staff reductions and the elimination of services.
"This analysis demonstrates that imposing Medicaid work requirements could have a detrimental effect not only for people who could lose their healthcare coverage, but on hospital finances," said Commonwealth Fund President David Blumenthal, MD.
"The way that states design these work requirements will play a big role in the severity of the loss," he said.
Because most people who lose Medicaid coverage are ineligible for premium subsidies in the health insurance marketplaces and would not have jobs that offer employer-sponsored insurance, many would become permanently or temporarily uninsured.
The study's findings extrapolate the early results of Medicaid coverage loss after Arkansas implemented work requirements in June 2018, targeting enrollees that became eligible through the ACA Medicaid expansion.
The state started work requirements for enrollees ages 30 to 49 and expanded to enrollees ages 19 to 29 in January 2019.
Nearly 8,500 people lost their Medicaid coverage within the first four months of the program. Between 23% and 29% of the targeted population either did not meet the work requirement or failed to report their work activities each month.
Assuming these rates continue, nearly 50,000 (29%) of the state's estimated 167,000 Medicaid enrollees may lose their coverage, the report projected.
Hospitals in Indiana and Kentucky could take the biggest hit because those states apply work requirements to both the traditional Medicaid and expansion populations up to age 59 and 64, respectively.
In Kentucky, for example, Medicaid generates $30.2 million on average for the state's 88 hospitals, but the projected disenrollment could lop up to 22% ($6.7 million) in Medicaid funding, the study said.
In contrast, Arizona, Arkansas, and Ohio will apply work requirements only to the expansion population up to age 49, and the study estimates that hospital Medicaid revenues in those states will decline by 10% to 14%.
Medicaid work requirements would further reduce operating margins for rural hospitals that are already operating at a loss on patient care. For example, Kentucky's stringent requirements could adversely affect hospital operating margins in that state between -1.7% to -3.1%.
