One reason US Hospital bills are so high is that many of the larger Hospitals Systems set their pricing for hospital procedures so that they make a lot of money.
Thus, US Hospitals are playing a key role in ultimately determining whether health insurance premiums are fairly priced on the health insurance exchanges.
Some Missouri Hospital Organizations are being very greedy in generating very high operating profits. But a clear majority of them are not.
The State of Missouri is being very transparent with its citizens by having available for review annually at its State Dept of Health website very detailed financial information on each of its 117 Short-term Acute Care Hospitals which disclosed their numbers. I excluded Mercy Hospital Joplin below because it had a huge operating loss, coupled with a massive insurance recovery gain, both due to the horrific tornado it had there in 2012.
These 117 Missouri Hospitals generated Total Operating Income of $779 mil in the most recent year reported, which was a modest 4.5% of their Total Operating Revenues of $17.180 bil.
On the negative side, 18 of these 117 Missouri Hospitals, all with Operating Income Margins as a Percentage of Total Operating Revenues of above 10.0%, generated Total Operating Income of $337 mil, which was a very steep 12.8% of their Total Operating Revenues.
But on the very positive side from a health insurance premium pricing perspective, there were 69 Missouri Hospitals with Operating Income Margins of below 5.0% each and 93 of them with Operating Income Margins of below 8.0% each.
Of these 117 Missouri Hospitals, 39 of them posted Operating Losses in the most recent year.
With so many of these Missouri Hospitals generating Operating Income Margins below 5.0% and even some others just above 5.0%, a key beneficiary of this will be Missouri citizens buying health insurance on the Federal insurance exchange. These Missouri Hospitals, for the most part, will not be baking in excessive Hospital profits demands in their negotiations with health insurance companies on pricing for hospital procedures which ultimately determines what insurance premiums are set by health insurance companies on the Federal insurance exchange.
Presently, Missouri has chosen not to Expand Medicaid. If Missouri were to change course and Fully Expand Medicaid, then the consequences of this action would be to further moderate insurance premium prices for Missouri residents in the Federal health insurance exchange. This Missouri Medicaid Expansion would increase Missouri Hospital profits substantially and thus permit Misspouri Hospitals to be even more reasonable in their negotiations with health insurance companies on pricing for hospital procedures which ultimately drives what health insurance premiums are set at by health insurers for Missouri residents on the Federal Health Insurance Exchange.
So just how much would Missouri Hospital Profits increase due to the ACA and the Expansion of Medicaid?
Well, from the information contained at the State of Missouri Health Dept website, the 117 Missouri Hospitals generated Total Operating Income of $779 mil in the most recent year, which included an Earnings Charge of a huge $1.238 bil due to Provisions for Bad Debts. Thus their Total Operating Income Before these Bad Debt Charges were $2.017 bil......yeah that's 2.6 times the Total Operating Income reported of $779 mil. But that's not all. In addition, the Total Uncompensated Charity Care Charges Foregone of these 117 Missouri Hospitals were another huge $1.539 bil in the most recent year.
Granted not all of these two huge Earnings Charges will be eliminated with ACA and Medicaid Expansion, but a substantial portion of them will.
Below here are Audited Operating Income or Loss, Total Operating Revenues and Operating Income (Loss) Margin Percentage in the most recent year for each of these 117 Missouri Hospitals:
| Operating | ||||
| Operating | Total | Income | ||
| Missouri | Income | Operating | (Loss) | |
| Hospital Name | City | (Loss) | Revenues | Margin |
| 000s | 000s | % | ||
| Shriners Hospitals for Children | St Louis | (20,579) | 7,337 | -280.5% |
| Ripley County Meml Hosp | Doniphon | (1,739) | 6,254 | -27.8% |
| Callaway Community Hospital | Fulton | (2,294) | 9,477 | -24.2% |
| Cooper County Meml Hospital | Boonville | (1,717) | 9,459 | -18.2% |
| I-70 Community Hospital | Sweet Springs | (831) | 6,111 | -13.6% |
| Community Hospital-Fairfax | Fairfax | (1,243) | 9,617 | -12.9% |
| Royal Oaks Hospital | Windsor | (1,049) | 9,933 | -10.6% |
| Pemiscot County Meml Hosp | Hayti | (3,449) | 37,674 | -9.2% |
| Truman Med Ctr Lakewood | Kansas City | (9,398) | 110,631 | -8.5% |
| St. Francis Hospital | Maryville | (4,261) | 54,427 | -7.8% |
| Bates County Meml Hospital | Butler | (1,701) | 27,314 | -6.2% |
| CenterPointe Hospital | St Charles | (1,810) | 29,421 | -6.2% |
| St Louis University Hospital | St Louis | (20,812) | 343,507 | -6.1% |
| Sac-Osage Hosp | Osceola | (400) | 6,640 | -6.0% |
| Mercy Hospital Washington | Washington | (4,961) | 87,550 | -5.7% |
| Putnam Ciunty Meml Hosp | Unionville | (324) | 6,359 | -5.1% |
| Northwest Med Ctr | Albany | (633) | 12,902 | -4.9% |
| Pike County Meml Hosp | Louisiana | (527) | 11,495 | -4.6% |
| Washington Meml Hosp | Potosi | (963) | 21,481 | -4.5% |
| Texas County Meml Hosp | Houston | (928) | 21,702 | -4.3% |
| Missouri Delta Med Ctr | Sikeston | (3,069) | 72,475 | -4.2% |
| Pershing Memorial Hospital | Brookfield | (614) | 14,916 | -4.1% |
| Barton County Meml Hospital | Lamar | (792) | 19,378 | -4.1% |
| St. Mary's Health Ctr | Jefferson City | (4,940) | 125,631 | -3.9% |
| Scotland County Hosp | Memphis | (488) | 16,143 | -3.0% |
| Ozarks Community Hospital | Springfield | (1,242) | 42,994 | -2.9% |
| Salem Meml District Hospital | Salem | (404) | 14,990 | -2.7% |
| Hermann Area District Hospital | Hermann | (402) | 15,111 | -2.7% |
| Christian Hospital | St Louis | (6,806) | 269,706 | -2.5% |
| Samaritan | Macon | (488) | 19,893 | -2.5% |
| Wright Memorial Hospital | Trenton | (589) | 24,474 | -2.4% |
| Saint Luke's Hospital of KC | Kansas City | (9,393) | 498,933 | -1.9% |
| Iron County Hospital | Pilot Knob | (115) | 7,438 | -1.5% |
| Liberty Hospital | Liberty | (2,548) | 175,185 | -1.5% |
| St Anthony's Med Ctr | St Louis | (5,571) | 411,588 | -1.4% |
| Sullivan County Meml Hosp | Milan | (63) | 6,304 | -1.0% |
| Audrain Medical Center | Mexico | (418) | 53,010 | -0.8% |
| Harrison County Community Hosp | Bethany | (33) | 13,954 | -0.2% |
| Children's Mercy Hospital | Kansas City | (1,000) | 709,589 | -0.1% |
| Crittenton Children's Center | Kansas City | 5 | 23,984 | 0.0% |
| Progress West HealthCare Ctr | O Fallon | 241 | 55,849 | 0.4% |
| Freeman Health System | Joplin | 3,035 | 369,928 | 0.8% |
| Lincoln County Med Ctr | Troy | 312 | 32,363 | 1.0% |
| Bothwell Reg Med Cre | Sedalia | 923 | 85,983 | 1.1% |
| Truman Med Ctr Hospital Hill | Kansas City | 4,262 | 321,551 | 1.3% |
| Mineral Area Reg Med Ctr | Farmington | 542 | 40,541 | 1.3% |
| SSM St Clare Health Ctr | Fenton | 2,394 | 163,260 | 1.5% |
| Carroll County Meml Hospital | Carrollton | 174 | 11,794 | 1.5% |
| Missouri Baptist Hosp Sullivan | Sullivan | 670 | 40,671 | 1.6% |
| Lake Regional Health | Osage Beach | 2,719 | 154,794 | 1.8% |
| SSM St Joseph Health Ctr | St Charles | 3,313 | 184,998 | 1.8% |
| Western Missouri Med Ctr | Warrensburg | 1,329 | 67,561 | 2.0% |
| Ste. Genevieve County Mem Hosp | Sainte Genevieve | 628 | 31,389 | 2.0% |
| Citizens Meml Hospital | Bolivar | 1,936 | 92,129 | 2.1% |
| Madison Med Ctr | Fredericktown | 326 | 14,825 | 2.2% |
| Research Medical Center | Kansas City | 6,812 | 281,198 | 2.4% |
| University Hospital and Clinics | Columbia | 13,854 | 570,099 | 2.4% |
| St. Mary's Med Center Blue Springs | Blue Springs | 1,651 | 65,705 | 2.5% |
| St Luke's Hospital | Chesterfield | 11,037 | 432,032 | 2.6% |
| Ray County Meml Hosp | Richmond | 450 | 17,329 | 2.6% |
| Mercy Hospital Aurora | Aurora | 368 | 13,723 | 2.7% |
| Excelsior Springs Hospital | Excelsior Springs | 601 | 21,698 | 2.8% |
| Mercy McCune-Brooks Hospital | Carthage | 831 | 28,598 | 2.9% |
| CoxHealth | Springfield | 25,376 | 806,591 | 3.1% |
| Ellett Meml Hosp | Appleton City | 253 | 7,680 | 3.3% |
| Barnes-Jewish Hospital | St Louis | 62,999 | 1,642,386 | 3.8% |
| Fitzgibbon Hosp | Marshall | 1,435 | 36,734 | 3.9% |
| Landmark Hospital of Joplin | Joplin | 631 | 15,135 | 4.2% |
| Capital Region Med Ctr | Jefferson City | 7,836 | 159,318 | 4.9% |
| Parkland Health Ctr-Farmington | Farmington | 3,397 | 68,401 | 5.0% |
| Landmark Hosp Cape Girardeau | Cape Girardeau | 730 | 14,547 | 5.0% |
| Southeast Hospital | Cape Girardeau | 14,269 | 277,239 | 5.1% |
| Landmark Hospital of Columbia | Columbia | 901 | 17,420 | 5.2% |
| Nevada Reg Med Ctr | Nevada | 1,664 | 31,552 | 5.3% |
| Hannibal Reg Hospital | Hannibal | 5,539 | 103,261 | 5.4% |
| SSM St Mary's Heallth Ctr | Richmond Heights | 15,713 | 287,088 | 5.5% |
| Cedar County Meml Hospital | El Dorado Springs | 684 | 11,631 | 5.9% |
| Des Peres Hospital | St Louis | 7,314 | 122,596 | 6.0% |
| North Kansas City Hospital | Kansas City | 23,596 | 375,617 | 6.3% |
| Perry County Meml Hosp | Perryville | 1,794 | 28,369 | 6.3% |
| Cass Reg Med Ctr | Harrisonville | 3,198 | 50,383 | 6.3% |
| St. Joseph Med Ctr of KC | Kansas City | 10,325 | 160,839 | 6.4% |
| Golden Valley Meml Hospital | Clinton | 3,775 | 58,762 | 6.4% |
| Lafayette Reg Health Ctr | Lexington | 1,646 | 24,288 | 6.8% |
| Ozarks Medical Center | West Plains | 8,030 | 115,877 | 6.9% |
| Cox Monett | Monett | 1,842 | 26,345 | 7.0% |
| Cameron Reg Med Ctr | Cameron | 2,522 | 35,905 | 7.0% |
| St Louis Children's Hospital | St Louis | 34,639 | 486,285 | 7.1% |
| St Alexius Hosp-Broadway | St Louis | 4,259 | 58,234 | 7.3% |
| Mercy St. Francis Hospital | Mountain View | 1,047 | 14,171 | 7.4% |
| St. Luke's Northland Hosp-Barry Road | Kansas City | 7,825 | 104,647 | 7.5% |
| Heartland Regional Medical Ctr | St Joseph | 36,690 | 480,090 | 7.6% |
| SSM DePaul Health Ctr | Bridgeton | 24,877 | 312,964 | 7.9% |
| Saint Francis Med Ctr | Cape Girardeau | 27,362 | 332,479 | 8.2% |
| Boone Hospital Center | Columbia | 24,911 | 300,635 | 8.3% |
| Barnes-Jewish St Peters Hosp | St Peters | 10,367 | 121,671 | 8.5% |
| SSM St Joseph Hosp West | Lake St Louis | 10,730 | 124,361 | 8.6% |
| Mercy Hospital St Louis | St Louis | 71,248 | 792,462 | 9.0% |
| Missouri Baptist Med Ctr | St Louis | 42,790 | 474,315 | 9.0% |
| Mercy Hospital Springfield | Springfield | 115,896 | 1,140,432 | 10.2% |
| SSM Cardinal Glennon Children's Med Ctr | St Louis | 33,025 | 309,980 | 10.7% |
| St Luke's East Lee's Summit Hosp | Lee's Summit | 15,490 | 140,882 | 11.0% |
| Barnes-Jewish West County Hosp | St Louis | 11,765 | 106,590 | 11.0% |
| Phelps County Reg Med Ctr | Rolla | 15,409 | 138,853 | 11.1% |
| Hedrick Med Ctr | Chillicothe | 4,120 | 35,264 | 11.7% |
| Saint Luke's Cancer Institute | Kansas City | 2,249 | 19,185 | 11.7% |
| Centerpoint Med Ctr Independence | Independence | 26,078 | 197,858 | 13.2% |
| Southeast Health Ctr Stoddard | Dexter | 1,409 | 10,434 | 13.5% |
| Poplar Bluff Reg Med Ctr | Poplar Bluff | 20,004 | 137,482 | 14.6% |
| Freeman Neosho Hospital | Neosho | 2,938 | 18,336 | 16.0% |
| Mercy Hospital Cassville | Cassville | 2,272 | 13,129 | 17.3% |
| Lee's Summit Med Ctr | Lee's Summit | 13,510 | 72,744 | 18.6% |
| Belton Reg Med Ctr | Belton | 7,342 | 39,488 | 18.6% |
| Northeast Regional Med Ctr | Kirksville | 15,377 | 66,162 | 23.2% |
| Mercy Hospital Lebanon | Lebanon | 19,963 | 80,832 | 24.7% |
| Moberly Reg Med Ctr | Moberly | 16,839 | 62,956 | 26.7% |
| Twin Rivers Reg Med Ctr | Kennett | 13,414 | 46,072 | 29.1% |
| - | ||||
| Total all 117 | 779,133 | 17,179,962 | 4.5% |
