Either action could add millions to the ranks of uninsured patients across the country. Health executives interviewed by the
"I think jobs will be at stake here," said
Cuts to Medicaid, the government-paid health insurance for the poor, loom. So do premium hikes for those between ages 50 and 64, along with waivers that let states limit coverage and charge more to people with pre-existing conditions.
Trump has built House-passed cuts to Medicaid and other programs such as the
"We're no longer going to measure compassion by the number of programs or the number of people on those programs, but by the number of people we help get off those programs," Trump budget director
Trump's secretary of
14 million more uninsured
"There is no question we would lose revenue from what's in
This is because the CBO projects that the current version of the
Uncompensated care was down statewide as a result of the ACA, which passed in 2010 and expanded access to Medicaid, explained
"It is more than fair to say that uncompensated care will go up if the ACA is repealed or Medicaid is cut as significantly as is proposed in the Trump budget or in the
The upshot is that those losing health insurance coverage, those whose benefits expire, or those too sick to fit affordably in an actuarial pool will still need medical care. They will just have no way to pay for it.
Hospitals, meanwhile, are legally -- if not morally -- bound to treat sick people without regard to their ability to pay.
Uncompensated care -- the total of charity care and bad debt -- has shrunk as a percentage of gross patient revenue in many
From 2010 to 2016
"We historically had experienced uncompensated care in the 3.5 to 4 percent range," said
Accumulated savings on uncompensated care are at risk under the new budget and health care proposal, administrators warn, and the rates easily could rise above pre-ACA levels.
Rural medical care crisis
If 23 million more Americans end up without health coverage, Conrad thinks there could be a rural medical care crisis in
A new health care law and budget also could compel changes in care delivery.
"We will work hard for a margin to sustain ourselves," said
At hospitals that care for large numbers of low-income patients, adding to the rolls of the indigent by cutting Medicaid threatens a business model.
"We've been on this journey of lean management for 15 years," said Dr.
Hospital administrators argue that Medicaid and Medicare payments already fail to cover costs of care to the growing number of patients in the two government plans. Statewide, the
Adding legislation that could cost 14 million people health insurance coverage in a single year while at the same time capping lifetime benefits for some insured people and possibly pricing some patients with pre-existing conditions out of the insurance market is a toxic recipe for the hospital business, said Korsmo.
"We cannot afford a significantly greater burden of uncompensated care," he said.
Sense of entitlement
The state hospital association's Burt said 38 hospitals in
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