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ACA Medicaid Expansion: December 2014

| Dec 30, 2014 | healthcare, Medicaid, Medicaid Expansion |

PBS NEWSHOUR,, reports hospitals in states that approved ACA Medicaid expansion enjoy financial gains, but hospitals in states that refused expansion are paying dearly. The PBS report compares Harborview Medical Center, Seattle, Washington, and  Winchester Medical Center, Winchester, Virginia.

Both hospitals suffer the large cuts in federal payments that defray a decreasing percentage of the huge losses incurred by hospitals when caring for the uninsured. But the Washington hospital reaps a reward that the Virginia hospital is denied.


The state of Washington accepts ACA funds to expand Medicaid, and the state of Virginia does not.


The percentage of uninsured patients at Harborview Medical Center has fallen from 14% to 4%, says PBS. In contrast, Winchester Medical Center’s percentage of uninsured has “declined very little.” Harborview paying patients increase to cover or exceed the cuts in federal funds for unpaid bills. Winchester suffers the cuts without the benefit of more paying patients.


Sarah Varney, Kaiser Health News, reported that some hospital executives say “the divide between states expanding Medicaid and those that have not could lead to a new type of two-tiered system in U.S. hospitals–between those able to maintain robust services in states like Washington . . . and those like Virginia, sliding into greater financial uncertainty.”

Varney, further, reported an expectation that unpaid hospital bills will fall by $4.2 billion in states that expanded Medicaid, but only fall $1,5 billion in the states that did not. The source of this expectation was not reported.


Realistically, a “two-tiered system in U. S. hospitals” is improbable. For starters, hospitals–a major stakeholder in healthcare reform–will not abide such a two-tiered system.

ACA 2015

The prospect of enormous financial disparity in hospitals based on the state in which they are located is important in the continuing ACA debate. However, like many issues of importance in the debate, it clearly favors neither those avidly supporting the ACA nor those avidly opposing it. Instead, it highlights the complexity of healthcare reform.

The disparity observed by PBS is an artifact of the U.S. Supreme Court decision that struck down the requirement that all states expand Medicaid. One of many heavy blows dealt the ACA–with more to come–as it plows its twisting furrow into the New Year.