Tennessee Hospital Profits Will Increase Sharply If Medicaid Is Expanded

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are humongous, especially when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA) and the SEC filings, I found 9 Tennessee Hospital Organization with Net Assets above $400 mil currently.  When I remove the one large St Jude Children's Research Hospital in Memphis, that leaves 8.  Below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for these 8 Tennessee Hospital Organizations:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Tennessee Hospital Organizations
HCA		Dec 2012	3,770	2,381	6,151	2,894
Community Health Systems		Dec 2012	1,959	125	2,084	619
LifePoint Hospitals		Dec 2012	624	31	655	244
Baptist Memorial Health Memphis		Sep 2012	249	55	304	(42)
Methodist LeBonheur Healthcare		Dec 2012	135	88	223	58
Mountain States Health Alliance		Jun 2012	123	25	148	8
Covenant Health		Dec 2012	86	30	116	-
Wellmont Health System		Jun 2012	55	16	71	13
Total all 8			7,001	2,751	9,752	3,794
Provision for Bad Debts						7,001
Uncompensated Charity Care Costs						2,751
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						13,546

So, these 8 Tennessee Hospital Organizations had Audited Total Hospital Operating Income of $3.794 bil in the most recent fiscal year audited.  Driving down this $3.794 bil Total Hospital Operating Income were Total Provisions for Bad Debts of a massive $7.001 bil and Total Costs of Uncompensated Charity Care of another huge $2.751 bil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $13.546 bil, which is an incredibly large $9.752 bil higher than the reported $3.794 bil.
 
Granted these two gigantic earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two huge earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

I really can't understand why some State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt load like this.

Very financially astute Republican State Governors like Ohio's John Kasich and Florida's Rick Scott, who also has a particularly keen insight on this issue since he was formerly a CEO of a large hospital organization, already have this all figured out.  And so have other Republican Governors.

And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations.  For instance, Tennessee-HQed companies LifePoint Hospitals has had its stock price advance by 112% and Community Health Systems by 130% since the beginning of the Obama Administration.  And a smaller Tennessee company Acadia Healthcare, an acquirer and developer of Inpatient Behavioral Healthcare facilities, has seen its stock market price close today at $39.33, an increase of 3,646% from the $1.05 it was trading at just before the Obama Administration took office.  

Texas Hospital Profits Will Massively Increase If Medicaid Is Expanded

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are humongous, especially when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA) and the SEC filings, I found 17 Texas Hospital Organization with Net Assets above $400 mil currently.  When I remove the three large Children's Hospitals as well as the four large County District Hospitals, that leaves 10.  Below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for these 10 Texas Hospital Organizations:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Texas Hospital Organizations
Tenet Healthcare		Dec 2012	785	437	1,222	334
Memorial Hermann Healthcare		Jun 2013	634	136	770	166
Texas Health Resources		Dec 2012	279	184	463	289
Christus Health		Jun 2013	239	196	435	73
Baylor Health Care System		Jun 2012	240	152	392	264
The Methodist Hospital System		Dec 2012	137	178	315	144
Scott & White Healthcare		Aug 2012	215	65	280	65
Methodist Health System Dallas		Sep 2012	67	125	192	116
St Luke's Episcopal Health		Dec 2012	80	35	115	60
Baylor College of Medicine		Jun 2013	13	93	106	(16)
Total all 10			2,689	1,601	4,290	1,495
Provision for Bad Debts						2,689
Uncompensated Charity Care Costs						1,601
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						5,785

So, these 10 Texas Hospital Organizations had Audited Total Hospital Operating Income of $1.495 bil in the most recent fiscal year audited.  Driving down this $1.495 bil Total Hospital Operating Income were Total Provisions for Bad Debts of a massive $2.689 bil and Total Costs of Uncompensated Charity Care of another huge $1.601 bil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $5.785 bil, which is an incredibly large $4.290 bil higher than the reported $1.495 bil.
 
Granted these two gigantic earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two huge earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

I really can't understand why some State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt load like this.

Very financially astute Republican State Governors like Ohio's John Kasich and Florida's Rick Scott, who also has a keen insight on this issue since he was formerly a CEO of a large hospital organization, already have this all figured out.  And so have other Republican Governors.

And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations.  For instance, Texas-HQed Tenet Healthcare had its stock price close today at $45.27, which was an 851% increase from the $4.76 it was trading at just before the Obama Administration took office.  

Nevada Hospital Profits Will Increase Nicely If Medicaid Is Expanded

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are large when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA), below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for the 3 Nevada Non-Profit Hospital Organizations which had Net Assets above $50 mil currently, with Renown Health the dominant one with Net Assets of $601 mil at June 30, 2013:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Nevada Hospital Organizations
Renown Health		Jun 2013	184	13	197	-
Carson Tahoe Regional Healthcare		Dec 2012	24	6	30	12
Univ Medical Center Southern Nevada		Jun 2012	50	-	50	(19)
Total all 3			258	19	277	(7)
Provision for Bad Debts						258
Uncompensated Charity Care Costs						19
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						270

So, these 3 Nevada Non-Profit Hospital Organizations had Audited Total Hospital Operating Loss of $7 mil in the most recent fiscal year audited.  Contributing to this $7 mil Total Hospital Operating Loss were Total Provisions for Bad Debts of $258 mil and Total Costs of Uncompensated Charity Care of another $19 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $270 mil, which is $277 mil higher than the reported $7 mil Operating Loss.
 
Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two large earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

I really can't understand why some State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt load like this.

Very financially astute Republican State Governors like Ohio's John Kasich and Florida's Rick Scott, who also has a keen insight on this issue since he was formerly a CEO of a large hospital organization, already have this all figured out.  And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations. 

Ohio Hospital Profits Will Sharply Increase Since Ohio Expanded Medicaid

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are very large when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA), below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for the 10 Ohio Non-Profit Hospital Organizations which had Net Assets above $400 mil currently.  I excluded below three Ohio Children's Hospitals: Nationwide Children's Hospital, Children's Hospital Cincinnati and Children's Hospital Medical Center at Akron:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Ohio Hospital Organizations
Cleveland Clinic Health System		Dec 2012	378	155	533	228
Catholic Health Partners		Dec 2012	255	161	416	129
OhioHealth		Jun 2012	99	105	204	229
UC Health (Cincinnati)		Jun 2012	80	98	178	33
Premier Health Partners		Dec 2012	45	94	139	47
Summa Health System		Dec 2012	98	38	136	18
University Hospitals Health Systems		Dec 2012	55	53	108	65
ProMedica Health Care		Dec 2012	83	24	107	82
Kettering Health Network		Dec 2012	69	31	100	13
Christ Hospital Health Network		Jun 2012	11	14	25	17
Total all 10			1,173	773	1,946	861
Provision for Bad Debts						1,173
Uncompensated Charity Care Costs						773
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						2,807

So, these 10 Ohio Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $861 mil in the most recent fiscal year audited.  Driving down this $861 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $1.173 bil and Total Costs of Uncompensated Charity Care of another $773 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $2.807 bil, which is $1.946 bil higher than the reported $861 mil.
 
Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two large earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

All of the above make the fiscal decision pretty straight forward, and Ohio Governor John Kasich did indeed make the right one by Expanding Medicaid.  Ohio citizens should be very pleased with his decision here.

I really can't understand why some other State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt by refusing to Expand Medicaid.

Florida's Rick Scott, who has a particularly keen insight on this issue since he was formerly a CEO of a large hospital organization, already has this all figured out.  And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations. 

Arizona Hospital Profits Will Sharply Increase Since Arizona Expanded Medicaid

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are very large when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA), below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for the 3 Arizona Non-Profit Hospital Organizations which had Net Assets above $400 mil currently:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Arizona Hospital Organizations
Banner Health		Dec 2012	488	149	637	290
Scottsdale Healthcare		Sep 2012	95	23	118	28
Nortern Arizona Healthcare		Jun 2013	105	3	108	30
Total all 3			688	175	863	348
Provision for Bad Debts						688
Uncompensated Charity Care Costs						175
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						1,211

So, these 3 Arizona Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $348 mil in the most recent fiscal year audited.  Driving down this $348 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $688 mil and Total Costs of Uncompensated Charity Care of another $175 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $1.211 bil, which is $863 mil higher than the reported $348 mil.
 
Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two large earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

All of the above make the fiscal decision pretty straight forward, and Arizona Governor Jan Brewer did indeed make the right one by Expanding Medicaid.  Arizona citizens should be very pleased with her decision here.

I really can't understand why some other State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt by refusing to Expand Medicaid.

Very financially astute Republican State Governors like Ohio's John Kasich and Florida's Rick Scott, who also has a keen insight on this issue since he was formerly a CEO of a large hospital organization, already have this all figured out.  And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations.
 

Georgia Hospital Profits Will Sharply Increase If Medicaid Is Expanded

Under the Affordable Care Act (ACA), Hospital Organizations' both future Hospital Operating Income and Bottom Line Income will be bolstered very robustly due to many of the Uninsured getting insurance and also due to the many of the Underinsured getting much better insurance.

And for Hospital Organizations operating hospitals in States electing to Expand Medicaid, this future Profit growth will be exceptionally robust.

There are specifically two items which will drive higher Hospital Organization profits due to the ACA and also especially due to States electing the Expansion of Medicaid.

First, there is the Operating Statement Provision for Bad Debts' earnings charge which will be dramatically reduced due to the substantially better insurance situation of hospital patients.  This Provision for Bad Debts' earnings charge is usually a separate report line on a Hospital Organization's audited Operating Statement.

And second, there is the Operating Statement Uncompensated Charity Care Costs' earnings charge for the amounts hospitals spend on charity care which will also be dramatically reduced.  This Estimated Costs for Uncompensated Charity Care is disclosed in a Hospital Organization's footnotes which accompany its audited financial statements.

So what about the amounts of these two items?  Well, they are very large, especially when compared to the related Hospital Operating Income.

From a review of the Electronic Municipal Market Access (EMMA), below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for the 9 Georgia Non-Profit Hospital Organizations which had Net Assets above $400 mil currently.  Children's Health Care Atlanta was not included below:

				One Year	One
			One Year	Estimated	Year	One
		Most	Provision	Cost of	Total	Year
		Recent	For	Uncompensated	Earnings	Hospital
		Annual	Bad	Charity	Charge	Operating
		FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
Georgia Hospital Organizations
Wellstar Health System		Jun 2012	185	99	284	97
Piedmont Health Care		Jun 2012	125	23	148	127
Gwinett Hospital System		Jun 2012	108	34	142	33
Northeast Georgia Health System		Sep 2012	77	27	104	44
Central Georgia Health System		Sep 2012	45	25	70	15
Phoebe Putney Health System		Jul 2012	44	24	68	15
Archbold Medical Center		Sep 2012	53	14	67	15
Hamilton Health Care System		Sep 2012	33	14	47	48
University Health (Richmond County)		Dec 2012	22	24	46	(6)
Total all 9			692	284	976	388
Provision for Bad Debts						692
Uncompensated Charity Care Costs						284
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						1,364

So, these 9 Georgia Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $388 mi1 in the most recent fiscal year audited.  Driving down this $388 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $692 mil and Total Costs of Uncompensated Charity Care of another $284 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $1.364 bil, which is $976 mil higher than the reported $388 mil.
 
Granted these two earnings charges will not be totally eliminated with the ACA and in combination with States electing to Expand Medicaid, but a substantial amount of these two earnings charges will be eliminated, and especially so if States elect to Expand Medicaid, which is the predominant driver of these two earnings charges being very substantially reduced.

And the above two large earnings charges are just for one year.

I really don't understand how a financially savvy State Governor and financially savvy State Legislatures could possibly vote to not Expand Medicaid.  The US Government is 100% funding the first three years of Medicaid Expansion.

Further, if Medicaid is Expanded, the Hospital Organizations will be getting these just huge increases in their annual earnings in each future year, which will ultimately accrue to the benefit of State citizens when they are hospitalized and will be paying much lower hospital charges.  It will also cut the US Debt markedly since the US Government is paying for a good chunk of these hospitalization charges.

I really can't understand why some State Governors and State Legislators would want to financially hammer their State Hospital Organizations, their State citizens and the US Government Debt load like this.

Very financially astute Republican State Governors like Ohio's John Kasich and Florida's Rick Scott, who also has a keen insight on this issue since he was formerly a CEO of a large hospital organization, already have this all figured out.  And so has Arizona Republican Governor Jan Brewer.  And so has the perceptive US stock market which has moved up dramatically the market prices of the common stocks of the Publicly-Held Hospital Organizations.