When passed in 2010, the Affordable Care Act called for significant cuts in future Medicare disproportionate share hospital payments (Medicare DSH) based on the expectation that hospitals would have far fewer of the uninsured patients such payments helped subsidize.  They would have fewer uninsured patients because of the reform law’s Medicaid expansion provisions and enhanced access to affordable health insurance.
But then the Supreme Court made Medicaid expansion optional instead of mandatory for states.
Today, 25 states have chosen either not to expand their Medicaid programs or have not decided what to do, but their hospitals still face the prospect of a future loss of Medicare DSH revenue without the full expected decline in the number of uninsured patients they serve.
Pennsylvania is one of those states that has not yet expanded its Medicaid program, although state officials are currently negotiating a possible expansion with the federal government; the Safety-Net Association of Pennsylvania (SNAP) supports such an expansion.  In the meantime, the state’s safety-net hospitals continue to face the prospect of a future loss of Medicare DSH revenue.
The loss of such revenue would threaten any provider, but safety-net hospitals appear to be especially at risk, as the New York Times reports in the article “Cuts in Hospital Subsidies Threaten Safety-Net Care.”  Learn about the challenges some hospitals and their low-income patients face as they await the loss of some Medicare DSH revenue without the expected increase in Medicaid patients in this Times article.