Killing the Affordable Care Act public health insurance exchange system and its premium subsidy program might cost U.S. hospitals more revenue than killing the ACA Medicaid expansion program.
A team of analysts hired by the Chicago-based American Hospital Association and the Washington-based Federation of American Hospitals includes predictions supporting that possibility in a look at how full or partial ACA repeal might affect hospitals.
Hospitals commissioned the analysis in an effort to persuade Donald Trump and members of Congress to think carefully about the possible effects on hospitals when they set about changing health system rules.
The United States now spends about $1 trillion on hospital services per year, according to National Health Expenditure data from the Centers for Medicare & Medicaid Services.
The hospital group analysts contend that the ACA coverage expansion elimination provisions in one repeal bill they reviewed, H.R. 3762, could have cost hospitals about $13 billion in 2018, and about $166 billion over the 10-year period from 2018 through 2026.
In the past, hospitals and hospital analysts have talked mainly about how the ACA Medicaid expansion program has decreased the number of uninsured patients coming in and increased revenue. Hospitals and hospital analysts have suggested that any benefits for hospitals from the ACA health insurance exchange program have been much smaller than the Medicaid expansion program benefits.
But, in the new analysis, the analysts present data suggesting that the ACA exchange program might be doing more than the Medicaid expansion program to improve hospitals’ finances.
The hospitals’ analysts estimate that the ACA expansion of Medicaid and the Children’s Health Insurance Program have helped about 10 million previously uninsured people get covered, and the ACA exchange program and exchange plan subsidies have helped about 10 million previously uninsured people get covered.
Eliminating the ACA coverage expansion programs immediately, without replacing them with comparable programs, could cost hospitals about $12 billion in revenue from newly covered Medicaid enrollees who returned to being uninsured in 2018, the analysts say.