To review, in the pre-ACA world, the federal government funneled extra money to hospitals that served an unusually large number of Medicaid & uninsured patients. This helps these hospitals make up for the fact that Medicaid and uninsured patients tend to pay a lot less. The ACA includes a significant boost in Medicaid reimbursements, and should lead to a decline in the number of uninsured patients between the individual mandate and Medicaid expansion. In theory these changes should help safety-net hospitals become less reliant on DSH payments. In practice, however, twenty-four states run by troglodytes have rejected Medicaid expansion, and will thus voluntarily decimate their safety-net hospitals.
|Illinois should thank Republican governor of Wisconsin and state legislature of Missouri for any new hospitals
that are built in the next five years.
The White House blog notes that the number of states accepting the original expansion of Medicaid under LBJ exactly matches the expansion under Obama, and that over the next four years, all but two states decided the expansion was worthwhile. Thus the current state of Medicaid expansion is not without precedent, even if it's completely immoral.