SAN FRANCISCO (Reuters)—A year and a half after the Affordable Care Act brought widespread reforms to the U.S. healthcare system, Chicago’s Cook County Health & Hospitals System has made its first profit in 180 years.
Seven hundred miles south, the fortunes of Atlanta’s primary public hospital, Grady Health System, haven’t improved, and it remains as dependent as ever on philanthropy and county funding to stay afloat.
The disparity between the two “safety net” hospitals, both of which serve a disproportionate share of their communities’ poorest patients, illustrates a growing divide nationwide.
In states like Illinois that have opted to accept federal money to expand Medicaid, some large, public hospitals are finding themselves on solid financial footing for the first time in decades, and formerly uninsured patients are now getting regular care.
But in states that did not expand the government medical program for the poor, primarily ones with conservative electorates opposed to Obamacare, including Georgia, the impact of the Affordable Care Act on public hospitals has been negligible.
While the public exchanges established by the federal government and 14 states have brought coverage to many previously uninsured people in all parts of the country, the effect on the poorest Americans varies drastically from state to state.
Nearly four million low-income, uninsured Americans living in states that didn’t expand Medicaid would have qualified for coverage had their states chosen to expand it, according to the Kaiser Family Foundation. And public hospitals in those states, many of which rely on bond markets for funding, are likely to feel the pinch even more acutely over time, experts said.
“Providers in these states are going to be at a disadvantage,” said Jim LeBuhn, senior director at Fitch Ratings. “It’s going to make it that much more challenging for these providers to maintain their financial profiles.”
Since the Affordable Care Act’s first open enrollment in 2013, the number of Americans covered under Medicaid has risen by 21%, to 71.1 million.
Nonprofit hospitals in the 30 states that expanded Medicaid reported on average 13% less bad debt from unpaid bills last year, according to Moody’s Investors Service. In contrast, according to Moody’s, such “hospitals in non-expansion states saw bad debt increase through much of the year.”
Hospitals in Medicaid expansion states, according to Kaiser, reported an average 32% decrease in uninsured patients and a 40% cut in unreimbursed costs of care for patients without the ability to pay, known in the industry as charity care costs. In non-expansion states, the number of uninsured patients declined by 4.4% and charity care costs dropped by 6.2%.