title: Uncompensated Care Burden May Mean Financial Vulnerability For Rural Hospitals In States That Did Not Expand Medicaid.
abstract: The implementation of the Affordable Care Act has led to a large decrease in the number of uninsured people. Yet uncompensated care will still occur, particularly in states where eligibility for Medicaid is not expanded. We compared rural hospitals in Medicaid expansion and nonexpansion states in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013. We found that rural hospitals in expansion states provided more dollars of uncompensated care than those in nonexpansion states and that the difference was at least partly driven by greater uncompensated costs associated with public programs such as Medicaid. We found higher dollar values of unrecoverable debt and charity care among non-critical access rural hospitals in nonexpansion states than among those in expansion states. Compared to hospitals in expansion states, those in nonexpansion states provided greater amounts of uncompensated care as a percentage of revenues and appeared to be more financially vulnerable; thus, these hospitals may be more likely to experience financial pressure or losses. Policy makers need to formulate strategies for maintaining access to care for rural populations residing in nonexpansion states.
authors.affiliation: Kristin L. Reiter (reiter@email.unc.edu) is an associate professor in the Department of Health Policy and Management and a research fellow in the Cecil G. Sheps Center for Health Services Research, both at the University of North Carolina (UNC) at Chapel Hill.
authors.forename: Kristin L
authors.initials: KL
authors.lastname: Reiter
authors.affiliation: Marissa Noles is senior consultant for Deloitte Consulting LLP, in Charlotte, North Carolina. She was a research assistant in the Cecil G. Sheps Center for Health Services Research at UNC at Chapel Hill.
authors.forename: Marissa
authors.initials: M
authors.lastname: Noles
authors.affiliation: George H. Pink is deputy director of the North Carolina Rural Health Research Center, the Humana Distinguished Professor in the Department of Health Policy and Management, and a senior research fellow in the Cecil G. Sheps Center for Health Services Research, all at UNC at Chapel Hill.
authors.forename: George H
authors.initials: GH
authors.lastname: Pink
mesh_terms: D006780:Hospitals, Rural / Q000191:economics*; D006801:Humans; D008484:Medicaid / Q000191:economics*; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D019035:Rural Health Services / Q000191:economics*; D017664:Uncompensated Care / Q000191:economics*; D014481:United States
keywords: Health Reform; Hospitals; Insurance Coverage < Insurance; Rural Health Care