Hospitals that serve especially large numbers of Medicaid and low-income patients still need Medicaid disproportionate share hospital payments (Medicaid DSH) to avoid red ink despite the expansion of Medicaid and the increase in the number of uninsured people fostered by the Affordable Care Act.
So concludes the Medicaid and CHIP Payment and Access Commission (MACPAC) the non-partisan legislative branch agency that advises Congress, the Secretary of the U.S. Department of Health and Human Services, and the states on Medicaid and Children’s Health Insurance Program issues.
In its March 2017 report to Congress, MACPAC writes that

In both expansion and non-expansion states, deemed DSH hospitals, which are statutorily required to receive DSH payments because they serve a high share of Medicaid-enrolled and low-income patients, continue to report negative operating margins before DSH payments.

This finding reflects the experience of Pennsylvania safety-net hospitals, most of which consider Medicaid DSH to be absolutely critical to their financial health and continued ability to serve their communities.

Learn more about this evaluation, and other facets of the Medicaid DSH program, in this March 2017 report from MACPAC to Congress.  Find a summary of the report here.