Wednesday, October 23, 2013

Virginia 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 Virginia 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
Virginia Hospital Organizations

Sentara HealthCare
Dec 2012              249              136              385              264
Inova Health System
Dec 2012               93              120              213              206
Mountain States Health
Jun 2012              123               25              148                 8
Carilion Clinic
Sep 2012               75               63              138               57
Riverside Healthcare
Dec 2010               81               18               99              (12)
Valley Health System
Dec 2012               42               42               84               11
Centra Health
Dec 2012               39               26               65               24
VCU Health
Jun 2012               13               13               26              133
Virginia Hospital Arlington
Dec 2012               12                 8               20               20

Total all 9

             727              451           1,178              711

Provision for Bad Debts

Estimated Costs of Uncompensated Charity Care


Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs       1,889

So, these 9 Virginia Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $711 mil in the most recent fiscal year audited.  Driving down this $711 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $727 mil and Total Costs of Uncompensated Charity Care of another $451 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $1.889 bil, which is $1.178 bil higher than the reported $711 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 Michigan Republican Governor Rick Snyder.  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.