Thursday, October 24, 2013

North Carolina 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 14 North Carolina 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
North Carolina Hospital Organizations

Carolina's Health Care System
Dec 2012              356              153              509          168
Novant Health
Dec 2012              180              123              303          185
Vidant Health
Sep 2012              138               47              185          112
Wake Forest Baptist Hospital
Jun 2012               91               91              182            46
Duke University Health System
Jun 2012               83               69              152          238
Cone Health
Sep 2012               74               61              135            21
Cape Fear Valley Health
Sep 2012              113               22              135            14
WakeMed Health
Sep 2012               47               79              126            55
Mission Health System
Sep 2012               94               22              116            56
New Hanover
Sep 2012               79                -                 79            29
CaroMont Health
Jun 2013               43               18               61            17
Univ North Carolina Hospitals
Jun 2012               57                -                 57          121
FirstHealth of the Carolinas
Sep 2012               38               14               52            25
Rex Healthcare
Jun 2012               27                -                 27            56

Total all 14

          1,420              699           2,119       1,143

Provision for Bad Debts

Uncompensated Charity Care Costs


Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs

So, these 14 North Carolina Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $1.143 bi1 mil in the most recent fiscal year audited.  Driving down this $1.143 bil Total Hospital Operating Income were Total Provisions for Bad Debts of $1.420 bil and Total Costs of Uncompensated Charity Care of another $0.699 bil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $3.262 bil, which is $2.119 bil higher than the reported $1.143 bil.
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.