Thursday, October 24, 2013

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.