North Dakota Hospital Profits Will Increase Nicely With Full Rollout of Obamacare

Under the Affordable Care Act (ACA), Hospital Organizations' future Hospital Operating 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), I found 3 Non-Profit Hospital Organizations in the State of North Dakota with Net Assets above $100 mil each.  One of these was Sanford Health, which is headquartered in Sioux Falls, South Dakota but with two of its four Regional Medical Centers located in North Dakota.....in Bismark and in Fargo.

These 3 Non-Profit Hospital Organizations had very modest operating results in the most recent fiscal year.  But on the upside, the full rollout of Obamacare should substantially improve their profits.

Below here are the most recent audited year's Provision for Bad Debts and Uncompensated Charity Care Costs for each of these 3 North Dakota Non-Profit 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
	City	FYE	Debts	Care	of Both	Income
			mils $s	mils $s	mils $s	mils $s
North Dakota Non-Profit Hospital Organizations
Sanford	Bismark&Fargo	Jun 2013	130	47	177	31
Altru Health	Grand Forks	Dec 2012	25	24	49	13
St. Alexius Medical Center	Bismark	Jun 2013	13	2	15	(1)
Total of all 3			168	73	241	43
Provision for Bad Debts						168
Uncompensated Charity Care Costs						73
Operating Income Excluding Bad Debts and Uncompensated Charity Care Costs						284

So, these 3 North Dakota Non-Profit Hospital Organizations had Audited Total Hospital Operating Income of $43 mil in the most recent fiscal year audited.  Severely burdening this $43 mil Total Hospital Operating Income were Total Provisions for Bad Debts of $168 mil and Total Costs of Uncompensated Charity Care of another $73 mil.  Thus, exclusive of these two earnings charges, Total Hospital Operating Income would have been $284 mil, which is $241 mil higher than the reported $43 mil Hospital Operating Income.
 
Granted these two earnings charges will not be totally eliminated with the full rollout of the ACA, but a substantial amount of these two earnings charges will be eliminated, and especially so for States electing 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.

Frankly, 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.