Saturday, March 22, 2014

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.