US Hospital Net Assets Up 89% Under Obama and the Affordable Care Act...Update #7

Below here is a summary by US State of Total Net Assets (Financial Strength or Total Assets minus Total Liabilities) at both the Most Recent Date (mostly December 31, 2013) disclosed in a Hospital Organization's internet published balance sheet (overwhelmingly audited) and also at a date very early in the beginning of the Obama Administration (also audited).

Included here are all US Hospital Organizations with Net Assets above $400 mil each plus also a somewhat lower dollar threshold amount for a handful of the smaller US States.  The below chart is sorted by Net Asset Percentage Growth during the Obama Administration so far:

			Balance Sheet	Net Asset
	Number of	Most Recent	Net Assets at	% Growth
	Hospital	Balance Sheet	Beginning of	During
US State	Organizations	Net Assets	Obama Admin	Obama Admin
		mil $s	mil $s
Tennessee	12	10,297	221	4559%
Alabama	4	3,145	644	388%
Utah	2	5,618	1,923	192%
Minnesota	9	16,954	6,197	174%
New Jersey	8	6,170	2,359	162%
New Mexico	1	1,750	706	148%
Arizona	3	5,718	2,458	133%
New York	11	20,239	9,235	119%
Hawaii	2	1,669	776	115%
Virginia	9	13,108	6,107	115%
Maryland	6	8,933	4,234	111%
Indiana	10	14,997	7,125	110%
Vermont	1	679	341	99%
Connecticut	5	4,057	2,040	99%
Missouri	11	33,700	17,163	96%
Delaware	2	2,256	1,157	95%
Washington DC	3	3,082	1,599	93%
Ohio	15	26,674	13,851	93%
California	31	78,115	40,594	92%
Pennsylvania	19	32,555	17,123	90%
West Virginia	2	1,551	819	89%
Wisconsin	12	11,990	6,492	85%
Illinois	17	26,022	14,219	83%
Washington	8	14,860	8,204	81%
Louisiana	4	3,085	1,713	80%
Kansas	2	1,133	630	80%
Florida	20	28,688	15,979	80%
South Dakota	3	4,002	2,243	78%
Kentucky	5	4,429	2,501	77%
Michigan	11	20,123	11,467	75%
Colorado	7	21,233	12,390	71%
Iowa	3	4,043	2,423	67%
Texas	21	34,888	21,015	66%
Georgia	11	10,339	6,249	65%
New Hampshire	4	1,165	720	62%
Oregon	4	4,353	2,709	61%
North Carolina	15	19,910	12,413	60%
Alaska	3	1,275	814	57%
North Dakota	3	2,346	1,504	56%
Nevada	4	1,302	846	54%
Maine	2	939	611	54%
Idaho	2	1,438	952	51%
Oklahoma	4	4,598	3,051	51%
Nebraska	5	2,556	1,706	50%
Massachusetts	11	18,763	12,609	49%
Montana	2	567	394	44%
South Carolina	7	4,977	3,474	43%
Arkansas	3	2,322	1,673	39%
Wyoming	3	764	555	38%
Rhode Island	2	1,868	1,515	23%
Mississippi	5	2,523	2,197	15%
Total all 50 States & DC	369	547,768	289,940	89%

The single number that will determine by far more than any other one number just how successful the Affordable Care Act (ACA) will turn out to be in the long run is the Hospital Net Asset (Financial Strength) amount and its change over time.  This Hospital Net Asset number and its change over time will drive how expensive health insurance premiums will be, including insurance premiums in the Health Insurance Exchange under the ACA.  And this Hospital Net Asset number and its change over time will also drive the Total US Health Care Cost Curve.

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 369 US Hospital Organizations, with their Most Recent Balance Sheet Net Assets of more than $400 mil each plus a handful more of Hospitals in smaller States, totaled a huge $547.8 bil, up a massive 89% from such Total Net Asset amounts at the beginning of the Obama Administration.  That's a very good sign for just how successful the ACA will turn out to be.

This 89% Hospital Net Asset (Financial Strength) growth so far during the Obama Administration clearly says not only that the ACA has been and will continue to be be highly successful, but also that among many other things, Obama is clearly the Hospital President.

Reviewing the top of the above chart, Tennessee's phenomenal Net Asset growth is helped much by a massive Net Deficit improvement for publicly-held Hospital HCA.

Alabama's huge Net Asset Growth is driven by publicly-held Hospital HealthSouth.

The US State with the highest Net Asset growth for only Non-Profit Hospital Organizations is Utah with 192% growth, followed by Minnesota, which registered 174% Net Asset growth, and then followed by New Jersey's 162% Net Asset growth. 

Hospital Organizations headquartered in the State of California had by far the highest Total Current Net Assets at $78.1 bil, led by Kaiser Permanente's $23.0 bil.  And Kaiser Permanente's just released exceptional first quarter 2014 Bottom Line Earnings of $1.1 bil are not included in this $23.0 bil since KP hasn't yet released its Total Net Assets at March 31, 2014.  When it does, that should move the needle from 89% US Total Net Asset growth so far during the Obama Administration to 90% growth, and on its way to at least 100% growth by the end of 2014. 

Hospital Organizations headquartered in Missouri came in second with Total Current Net Assets of $33.7 bil, led by Ascension Health's $18.2 bil.

If you wish to see the individual Hospital Organizations making up a State's above Net Asset amounts, you simply click on the US State post shown on the right hand side of the computer screen.  These US State posts are shown pretty much in alphabetical order, except that Rhode Island is shown first because I mistakenly missed it on the first go round.

I'll keep updating these Hospital Net Asset amounts when more late reporting Hospital Organizations publish their predominately audited December 31, 2013 financial statements on the Electronic Municipal Market Access (EMMA).
 
With such incredibly impressive Hospital Net Asset percentage increases all throughout the US, a key beneficiary of this will be US citizens who elected to buy health insurance on the Health Insurance Exchange.  This superb Net Asset growth gives these US Hospitals the financial flexibility to moderate their pricing for hospital and other health care procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.

Next up.....studying just what is driving this massive Hospital Net Asset (Financial Strength) growth  by US State and its ramifications?

Rhode Island Non-Profit Hospitals Net Assets Up 23% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA), I found 2 Non-Profit Hospital Organizations headquartered in the State of Rhode Island with Net Assets (i.e. Financial Strength or Total Assets minus Total Liabilities) at the most recent date of more than $300 mil each.

Below here are the Net Assets of these 2 Rhode Island Hospital Organizations at both the most recent reported date and also at the Fiscal Year End (FYE) closest to the beginning of the Obama Administration:

						FYE	Balance	Net
				Most		Balance	Sheet	Assets
			Most	Recent		Sheet	Net	%
			Recent	Balance		Date	Assets	Change
			Balance	Sheet		Beginning	Beginning	During
	City	State	Sheet	Net		Obama	Obama	Obama
Rhode Island Hospital Organization	HQs	HQs	Date	Assets		Admin	Admin	Admin
				mil $s			mil $s
LifeSpan	Providence	RI	Dec 13	1,479		Sep 09	1,225	21%
Care New England Health	Providence	RI	Dec 13	389		Sep 09	290	34%
Total of both				1,868			1,515	23%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 2 Rhode Island Non-Profit Hospital Organizations increased by 23% to $1.868 bil for their 4.25 years during the Obama Administration.

The State of Rhode Island has elected to fully expand Medicaid, which substantially improves the profits and thus also the Net Assets of all Rhode Island Hospitals, particularly the ones that are struggling financially.  When you combine this with the fact that these 2 Rhode Island Hospitals have increased their Net Assets by 23% for 4.25 years during the Obama Administration, a key beneficiary here will be Rhode Island citizens electing to buy health insurance on the Health Insurance Exchange.  This solid Net Asset growth gives these Rhode Island Hospitals the financial flexibility to moderate their pricing for hospital procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange. 

Alaska Non-Profit Hospitals Net Assets Up 57% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA), I found 2 Non-Profit Hospital Organizations and 1 Hospital Foundation headquartered in the State of Alaska and with Net Assets (i.e. Financial Strength or Total Assets minus Total Liabilities) at the most recent date of more than $50 mil each.  Below here are the Net Assets of these 3 at both the most recent reported date and also at the Fiscal Year End (FYE) closest to the beginning of the Obama Administration:

						FYE	Balance	Net
				Most		Balance	Sheet	Assets
			Most	Recent		Sheet	Net	%
			Recent	Balance		Date	Assets	Change
			Balance	Sheet		Beginning	Beginning	During
	City	State	Sheet	Net		Obama	Obama	Obama
Hospital Organization	HQs	HQs	Date	Assets		Admin	Admin	Admin
				mil $s			mil $s
Providence Health Alaska Region	Anchorage	AK	Dec 13	937		Dec 08	585	60%
Greater Fairbanks Community Hospital Foundation	Fairbanks	AK	Dec 13	284		Dec 08	195	46%
Fairbanks Memorial Hospital/Denali Center/Tanana Valley Clinic	Fairbanks	AK	Dec 13	54		Dec 08	35	56%
Total all 3				1,275			814	57%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 3 Alaska Hospital Organizations increased by a very robust 57% for their average 5.00 years so far during the Obama Administration.

Very positively impacting this very robust increase in the Net Assets (Financial Strength) of these 3 Alaska Hospital Organizations were actions taken by both the Obama Administration and the US Fed to strengthen the US Financial Foundation which was severely damaged from the financial meltdown in late 2008.

In addition, the Affordable Care Act (ACA) has also played a key role in this impressive increase in Net Assets (Financial Strength) of these 3 Alaska Non-Profit Hospital Organizations.

A remarkable thing is that these very robust increases in Net Assets (Financial Strength) of these Non-Profit Hospital Organizations occurred when these Non-Profit Hospitals were also playing very instrumental roles in the substantial annual percentage growth reduction of Total US Health Care Costs which occurred in each of the most recent three years under the ACA.

With such impressive Net Asset percentage increases of these 3 Alaska Hospital Organizations, a key beneficiary of this will be Alaska citizens electing to buy health insurance on the Health Insurance Exchange.  This strong Net Asset growth gives these Alaska Hospitals the financial flexibility to moderate their pricing for hospital and other health care procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.

Alabama Hospitals Net Assets Up 388% Under Obama and the Affordable Care Act

From a review of the Electronic Municipal Market Access (EMMA) and SEC filings, I found 3 Non-Profit Hospital Organizations and 1 Publicly-held Hospital Organization all headquartered in the State of Alabama and all with Net Assets (i.e. Financial Strength or Total Assets minus Total Liabilities) at the most recent date of more than $400 mil each.

Below here are the Net Assets of these 4 Alabama Hospital Organizations at both the most recent reported date and also at the Fiscal Year End (FYE) closest to the beginning of the Obama Administration:

						FYE	Balance	Net
				Most		Balance	Sheet	Assets
			Most	Recent		Sheet	Net	%
			Recent	Balance		Date	Assets	Change
			Balance	Sheet		Beginning	Beginning	During
	City	State	Sheet	Net		Obama	Obama	Obama
Alabama Hospital Organization	HQs	HQs	Date	Assets		Admin	Admin	Admin
				mil $s			mil $s
Non-Profit Hospitals
UAB Health System	Birmingham	AL	Dec 13	1,003		Sep 09	744	35%
Children's Hospital Alabama	Birmingham	AL	Dec 13	858		Dec 08	418	105%
City of Huntsville Health Care Authority	Huntsville	AL	Dec 13	815		Jun 09	569	43%
Total all 3 Non-Profit Hospitals				2,676			1,731	55%
Publicly-held Hospital Company
HealthSouth	Birmingham	AL	Dec 13	469		Dec 08	(1,087)	143%
Total all 4 Non-Profit and Publicly-held Hospitals				3,145			644	388%

As you can see from the above chart, the Total Net Assets (Financial Strength) of these 4 Alabama Non-Profit and Publicly-held Hospitals increased by a spectacularly off-the-charts 388% to $3.145 bil for their average 4.69 years during the Obama Administration.

Very positively impacting this  phenomenal increase in the Net Assets (Financial Strength) of these 4 Alabama Hospital Organizations were actions taken by both the Obama Administration and the US Fed to strengthen the US Financial Foundation which was severely damaged from the financial meltdown in late 2008.

In addition, the Affordable Care Act (ACA) has also played a key role in this very impressive increase in Net Assets (Financial Strength) of these 4 Alabama Hospital Organizations.

A remarkable thing is that these very robust increases in Net Assets (Financial Strength) of these Hospital Organizations occurred when these Hospitals were also playing very instrumental roles in the substantial annual percentage growth reduction of Total US Health Care Costs which occurred in each of the most recent three years under the ACA.

With such impressive Net Asset percentage increases of these 4 Alabama Hospitals, a key beneficiary of this will be Alabama citizens electing to buy health insurance on the Health Insurance Exchange.  This exceptionally strong Net Asset growth gives these Alabama Hospitals the financial flexibility to moderate their pricing for hospital procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.

If Alabama were to elect full Medicaid expansion, there would be a substantial increase in profits and thus also in Net Assets in all Alabama Hospitals, which would likewise give these Alabama Hospitals the financial flexibility to moderate their pricing for hospital procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.

Alabama Struggling Hospitals

From EMMA, I found 18 Alabama Non-Profit Hospital Organizations with Total Operating Revenues of $10 mil or more.  Below here are the 10 of them with Operating Income as a Percentage of Total Operating Revenues below 2.0%:

				Operating
		Operating	Total	Income	Fiscal
	City	Income	Operating	(Loss)	Year
	HQs	(Loss)	Revenues	Margin	End
		mils $s	mils $s	%
Alabama Non-Profit Hospital Organizations
Henry County Health Care Auth	Abbeville	(0.6)	11	-5.5%	Jun 12
Bibb County Health Care Auth	Centreville	(0.6)	14	-4.3%	Sep 12
Jackson County Health Care Auth	Scottsboro	(2.2)	52	-4.2%	Sep 12
Monroe County Health Care Auth	Monroeville	(0.8)	22	-3.6%	Sep 12
Houston County Health Auth	Dothan	(3.8)	292	-1.3%	Sep 13
Infirmary Health System	Mobile	(7.7)	597	-1.3%	Mar 13
Marshall County Health Auth	Guntersville	(1.6)	139	-1.2%	Sep 13
Baptist Health System	Birmingham	0.8	554	0.1%	Dec 13
Colbert County NW Health Care Auth	Sheffield	1.2	111	1.1%	Sep 13
DCH Health Care Authority	Tuscaloosa	7.8	463	1.7%	Sep 13
Total all 10		(7.5)	2,255	-0.3%

As you can see from the above chart, the majority of Alabama Hospitals are struggling financially.

By far the best and only way to solve this financially devastating problem is for the State of Alabama to fully expand Medicaid.  If Alabama did this, with the resultant massive inflow of Patient Revenues from Medicaid expansion, all of these financially struggling Alabama Hospitals would get substantial operating profit improvement and thus also a very nice Net Asset improvement.

If Alabama were to expand Medicaid, one of the key beneficiaries of this resultant very healthy improvement in the Total Net Assets of all Alabama Hospitals would be Alabama citizens electing to buy health insurance on the Health Insurance Exchange.  This exceptional Net Asset growth from Medicaid expansion would give all Alabama Hospitals the financial flexibility to moderate their pricing for hospital and other health care procedures in their negotiations with health insurance companies which ultimately determines what insurance premium prices are set at by health insurance companies on the Health Insurance Exchange.