Hospitals cheered the bad-debt reduction that followed the Affordable Care Act’s implementation. Now, it’s coming back to haunt them.
That’s because the federal government is basing upcoming bonus payments to certain hospitals that serve low-income patients partly on bad-debt data from 2015.
At first blush, it doesn’t sound like a problem. But a closer look reveals that hospitals enjoyed historically low bad debt in 2015, a year when the ACA had extended coverage to millions of people through subsidized private coverage, Medicaid expansion and employer and individual mandates. The U.S. uninsured rate among those under 65 had fallen to 11.2%, a 38% decline from five years earlier, according to the Urban Institute.
Times have changed. New data show bad debt nationally has surpassed its pre-ACA levels, driven largely by the rise of high-deductible health plans that render even insured people unable to afford out-of-pocket responsibilities that run into the thousands.
In fiscal 2015, bad debt represented 5% of not-for-profit hospitals’ net patient revenue, but that ticked up to 7% in fiscal 2018, according to an analysis by analytics firm Franklin Trust Ratings. Moody’s Investors Service predicts not-for-profit hospitals’ bad debt will jump at least 8% in 2019.