The hospital reports providing less charity care.

The Patient Protection and Affordable Care Act (PPACA) may be helping hospitals in some ways but hurting them in others.

Executives at Springfield Hospital, a hospital in Vermont, shed some light on the effects of PPACA health insurance coverage expansion programs in a presentation given earlier this week to the state’s Green Mountain Care Board. The board regulates the cost of hospital services.

In states that expanded access to Medicaid, hospitals and hospital chains have said they are seeing far fewer uninsured patients, a modest increase in the percentage of patients with commercial insurance, and a big increase in the percentage of patients with Medicaid.

See also: PPACA continues to cut hospitals’ uninsured admission rate

Vermont took the PPACA Medicaid expansion money, and it had generous public health benefits programs before the Medicaid expansion took effect.

At Springfield Hospital, “we have seen a decline in charity care,” or care provided for uninsured patients with little ability to handle large bills out of their own pockets, the executives said. The hospital believes PPACA has increased the percentage of patients with some kind of coverage.

At this point, the increase in potential insurance program payment revenue has not translated into an actual increase, the executives said. “In the current fiscal year quarter,” the executives said, “we have experienced a surge in bad debts.”

The hospital is assuming, based on anecdotal evidence, that the increase in bad debt is due to a combination of PPACA coverage complications, PPACA coverage verification complications, and PPACA exchange plan designs that impose big deductible, co-payment and coinsurance responsibilities on the patients, the executives said.