/ en Wed, 06 Aug 2025 23:55:56 -0500 Fri, 25 Jul 25 11:28:44 -0500 /fact-sheets/2025-02-07-fact-sheet-budget-reconciliation-101 <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>Budget reconciliation is an optional process under the Congressional Budget Act of 1974 that allows for expedited consideration of certain fiscal legislation that makes changes to mandatory spending, revenues and/or the debt limit. This special fast-track procedure is designed to reconcile current law with assumptions contained in the annual budget resolution adopted by Congress. Reconciliation legislation is privileged and cannot be filibustered in the Senate, meaning it requires only a simple majority, instead of a three-fifths majority, to pass. The contents of a reconciliation bill are tightly controlled because the process restricts the Senate’s right to unlimited debate that exists for most other legislation. The Senate’s “Byrd rule” aims to prevent the inclusion of matter considered “extraneous” to the budgetary goals of the legislation. In recent years, reconciliation has been used to enact landmark fiscal legislation on a party line basis. The most recent examples include the Tax Cuts and Jobs Act (2017), the American Rescue Plan (2021) and the Inflation Reduction Act (2022).</p><h2>Understanding the Basics</h2><h3>Step 1: Budget Resolution</h3><ul><li>Before Congress can begin work on a reconciliation bill, it must first pass a concurrent budget resolution in the House and Senate. A budget resolution serves as a roadmap to guide fiscal decision-making in Congress. Unlike other bills, it does not go to the President’s desk for signature and does not have the force of law. A budget resolution that is being used for reconciliation will contain a series of “reconciliation instructions” to various committees of jurisdiction directing them to report legislation that meets a specified fiscal target, such as requiring a committee to reduce mandatory spending by no less than a certain amount or reduce revenue by no more than a certain amount. The numerical instructions provide the fiscal goals of the legislation and cannot dictate the substance of how the committees are to meet their instructions. Nevertheless, which committees are given instructions, and the magnitude of those instructions, can be indicative of potential areas of focus.<ul><li><span><strong>Example:</strong></span> Instructions to the Energy & Commerce Committee directing them to reduce mandatory spending by a large amount opens the door to spending cuts within health programs.</li></ul></li></ul><h3>Step 2: Committees Begin Work on Reconciliation Bill</h3><ul><li>The instructed committees begin drafting legislation consistent with their instructions from the budget resolution and then move legislation through the committee process. The Budget Committee takes each committee-reported measure and combines them into a single reconciliation bill to prepare for consideration before the House or Senate.<ul><li><span><strong>Clarifying Point:</strong></span> Committees that did not receive reconciliation instructions in the budget resolution are not involved in the process. Committees cannot include subject matter outside of their jurisdiction.</li></ul></li></ul><h3>Step 3: Debate and Passage</h3><ul><li>The House and Senate have different rules that govern how legislation is considered by the full chamber. In the House, the Rules Committee will establish guidelines for debate on the bill and decide whether members will be allowed to make amendments to the bill. A reconciliation bill is passed in the House with a simple majority consistent with their typical process.</li><li>In the Senate, debate is limited to 20 hours and only 51 votes are needed to pass the bill instead of the usual 60 votes.<ul><li><span><strong>Clarifying Point:</strong></span> Even after the 20 hours of debate has expired, senators are allowed to offer amendments and make other motions on the bill. These extra votes are often referred to as “vote-a-rama.” Amendments are voted on without debate until no more amendments are offered. At that point, the Senate will vote on final passage of the reconciliation bill.</li></ul></li></ul><h3>Step 4: Resolving Differences & Final Approval</h3><ul><li>Before the reconciliation bill can be sent to the President for signature or veto, Congress must work out any remaining differences between the House and Senate bills. Once both chambers of Congress have passed an identical bill, the bill heads to the President’s desk.<ul><li><span><strong>Example:</strong></span> The House passes the reconciliation bill first and sends it to the Senate. The Senate passes amendments making changes to the bill. The House will need to vote on this new version before sending it to the President’s desk.</li></ul></li></ul><h2>Diving Deeper: The Byrd Rule</h2><h3>The Byrd Rule sets six criteria to determine whether a provision can be included in a reconciliation bill or whether it is considered extraneous.</h3><ul><li>A provision that violates any one of the six Byrd rule tests can be removed from the bill if a senator raises a Byrd rule point of order, unless 60 senators vote to waive the point of order to allow that provision to stay in the bill.<ul><li><span><strong>Clarifying Point:</strong></span> The Presiding Officer in the Senate makes the determination whether provisions are consistent with the rules, based on advice from the Senate Parliamentarian.</li><li><span><strong>Clarifying Point:</strong></span> The Byrd Rule only applies to consideration in the Senate. However, the House must be careful in crafting their bill to ensure it follows the Byrd Rules parameters otherwise it will put the bill at risk in the Senate.</li></ul></li></ul><h3>Six Criteria Used to Determine Whether a Provision is “Extraneous”:</h3><ol><li><span><strong>No Budgetary Effect:</strong></span> Provision does not change mandatory spending or revenues.</li><li><span><strong>Not in Accordance with Instructions:</strong></span> Provision increases mandatory spending or reduces revenues, and the committee is not in compliance with its instructions.</li><li><span><strong>Outside Committee Jurisdiction:</strong></span> Provision falls outside the jurisdiction of the instructed committee.</li><li><span><strong>Incidental Budgetary Effect:</strong></span> Provision produces a change in mandatory spending or revenues that is merely incidental to its other components.</li><li><span><strong>Increases Deficit Beyond the Budget Window:</strong></span> Provision would increase the deficit in any year beyond the period covered by a committee’s reconciliation instruction (usually 10 years).</li><li><span><strong>Changes to Social Security:</strong></span> Provision makes changes to Title II of the Social Security Act.</li></ol></div><div class="col-md-4"><p><a href="/system/files/media/file/2025/02/Fact-Sheet-Budget-Reconciliation-101-20250207.pdf" target="_blank" title="Click here to download the Fact Sheet: Budget Reconciliation 101 PDF."><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Budget-Reconciliation-101-20250207.png" data-entity-uuid="f869be09-95e9-467e-8c28-e7fc30015205" data-entity-type="file" width="695" height="900"></a></p><p><div class="views-element-container"><div class="js-view-dom-id-b82f46ef8a1e54d955733044238e2e90da1dce89886a33ed9fbf0a1b954f3625"> <header> <h3>The Latest on the One Big Beautiful Bill Act</h3> </header> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00" title="Monday, July 28, 2025 - 10:16">Jul 28, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/headline/2025-07-21-cbo-projects-obbba-increase-uninsured-10-million-federal-deficit-34-trillion" hreflang="en">CBO projects OBBBA to increase uninsured by 10 million, federal deficit by $3.4 trillion</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-21T15:37:59-05:00" title="Monday, July 21, 2025 - 15:37">Jul 21, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/lettercomment/2025-07-16-aha-expresses-support-protect-medicaid-and-rural-hospitals-act" hreflang="en">AHA Expresses Support for Protect Medicaid and Rural Hospitals Act </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T14:21:17-05:00" title="Wednesday, July 16, 2025 - 14:21">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-16-chair-file-leadership-dialogue-continuing-work-strengthen-health-america-aha-president-and" hreflang="en">Chair File: Leadership Dialogue — Continuing the Work to Strengthen Health in America With AHA President and CEO Rick Pollack</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-16T10:53:03-05:00" title="Wednesday, July 16, 2025 - 10:53">Jul 16, 2025</time> </span> </div></div> <div class="views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/resources-one-big-beautiful-bill-act-signed-law-july-4-2025" hreflang="en">Resources on the One Big Beautiful Bill Act Signed Into Law July 4, 2025</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-15T14:49:30-05:00" title="Tuesday, July 15, 2025 - 14:49">Jul 15, 2025</time> </span> </div></div> <div class="more-link"><a href="/topics/budget-reconciliation">More on the One Big Beautiful Bill Act (OBBBA)</a></div> </div> </div> </p></div></div></div> h2 { color: #003087; } h3 { color: #002855; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } .views-field-title { font-weight: bold; } .views-field-created { color: #000000 !important; } .views-row { margin-bottom: 20px; } .views-element-container { border: solid black 1px; padding-left: 20px; padding-right: 20px; padding-bottom: 20px; } Fri, 07 Feb 2025 14:23:32 -0600 Fact Sheets /fact-sheets/2022-08-30-fact-sheet-rural-hospital-support-act-s4009-assistance-rural-community <div class="container"><div class="row"><div class="col-md-8"><h2><span>Background</span></h2><p>Medicare pays most acute care hospitals under the inpatient prospective payment system (IPPS). Some of these hospitals receive additional support from Medicare to help address potential financial challenges associated with being rural, geographically isolated and low volume. These programs are Medicare-dependent Hospitals (MDHs), Low-volume Adjustment (LVA) and Sole Community Hospitals (SCHs).</p><p><span><strong>Without action from Congress, the enhanced LVA and MDH programs will expire Sept. 30, 2025.</strong></span></p><h3><span>Why are these programs important?</span></h3><p>The network of providers that serves rural Americans is financially fragile and more dependent on Medicare revenue due to the high percentage of Medicare beneficiaries who live in rural areas. Rural residents also on average tend to be older, have lower incomes and higher rates of chronic illness than urban counterparts. This greater dependence on Medicare may make certain hospitals more financially vulnerable. Indeed, Medicare only pays 82% of hospital costs on average according to our latest analysis. Additionally, over 150 rural hospitals have closed or converted to other provider types since 2010. These designations protect the financial viability of small, rural hospitals to ensure they can continue providing patients access to care.</p><h3><span>Medicare-dependent Hospitals</span></h3><p>Congress established the MDH program in 1987 to help support small rural hospitals for which Medicare patients make up a significant percentage of inpatient days or discharges. MDHs are small, rural hospitals where at least 60% of their admissions or patient days are from Medicare patients. MDHs receive the IPPS rate plus 75% of the difference between the IPPS rate and their inflation-adjusted costs from one of three base years.</p><h3><span>Low-volume Adjustment</span></h3><p>Certain factors beyond providers’ control can affect the costs of furnishing services, including patient volume. This is particularly relevant in small and isolated communities where providers frequently cannot achieve economies of scale like larger hospitals. Congress established the LVA program in 2005 to help isolated, rural hospitals with a low number of discharges. Currently under the enhanced program, they must be more than 15 miles from another IPPS hospital and have fewer than 3,800 annual total discharges. These LVA hospitals receive a payment adjustment based on a sliding scale formula to ensure the patients and communities these hospitals serve continue to have access to care.</p><h3><span>Sole Community Hospitals</span></h3><p>The SCH program was created to maintain access to needed health services for Medicare beneficiaries in isolated communities. In order to be eligible for the program, SCHs must show that because of distance or geographic boundaries between hospitals, they are the sole source of inpatient hospital services reasonably available in a certain geographic area. They receive increased payments based on their cost per discharge in a base year.</p><h2><span>AHA Position — Cosponsor the Rural Hospital Support Act (S.335) & the Assistance for Rural Community Hospitals (ARCH) Act</span></h2><p>The Rural Hospital Support Act (S.335) includes the following important AHA-supported policies to ensure access to care:</p><ul><li>Permanently extends the MDH program and adds an additional base year that hospitals may choose for calculating payments.</li><li>Permanently extends the enhanced LVA program, which would continue to allow hospitals more than 15 miles from another IPPS hospital and have fewer than 3,800 annual total discharges to be eligible.</li><li>Adds a base year that SCHs may select for calculating their payments.</li></ul><p>The ARCH Act helps rural hospitals continue to serve their patients and communities by extending the current MDH and LVA programs by five years and will soon be reintroduced in the House.</p></div><div class="col-md-4"><a href="/system/files/media/file/2022/08/fact-sheet-rural-hospital-support-act-s4009-the-assistance-for-rural-community-hospitals-act-hr8747.pdf" target="_blank" title="Click here to Download the Fact Sheet: Rural Hospital Support Act (S.4009) & the Assistance for Rural Community Hospitals Act (H.R.8747)"><img src="/sites/default/files/inline-images/Page-1-fact-sheet-rural-hospital-support-act-the-assistance-for-rural-community-hospitals-act-20250205.png" data-entity-uuid="60a4126d-3db7-4725-81d8-adc2020afcef" data-entity-type="file" alt="Fact Sheet: Rural Hospital Support Act (S.1110) & the Assistance for Rural Community Hospitals Act (H.R.6430) page 1." width="681" height="900"></a></div></div></div> Fri, 25 Jul 2025 11:28:44 -0500 Fact Sheets /fact-sheets/2024-08-06-fact-sheet-extending-hospital-home-program <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>The hospital-at-home (H@H) model — where patients receive acute level care in their homes, rather than in a hospital — has emerged as an innovative and promising approach to provide high quality care to patients in the comfort of their homes. Since the start of the program, Congress has extended it three times: first in 2022 (Consolidated Appropriations Act of 2023) for two years, then again in 2024 (H.R. 10545, the American Relief Act) for 90 days, and most recently in 2025 (H.R. 1968, the Full-Year Continuing Appropriations and Extensions Act) for six months. These extensions received no score from the Congressional Budget Office. Congressional action is needed to extend the waivers for this program, which are now set to expire Sept. 30, 2025.</p><h2>AHA Take</h2><p>The AHA supports the <strong>Hospital Inpatient Services Modernization Act (H.R. 4313 / S.2237)</strong> introduced in the House by Reps. Vern Buchanan, R-Fla., Lloyd Smucker, R-P., and Dwight Evans, D-Pa., and in the Senate by Sens. Tim Scott, R-S.C., and Rev. Raphael Warnock, D-Ga. The bill extends the H@H waiver for five years through the end of 2030 and directs the Centers for Medicare & Medicaid Services (CMS) to conduct a new study of the program.</p><p>Hospitals and health systems see H@H programs as a safe and innovative way to care for patients in the comfort of their homes. This kind of care is well suited for medium acuity patients who need hospital-level care but are considered stable enough to be safely monitored from home. Rather than staying three days or longer in the hospital, these patients can be treated safely by their doctor and a team of medical professionals along with the patient’s support system at home.</p><p>A long-term extension of the H@H waiver will not only provide additional time to continue gathering data on quality improvement, cost savings, and patient experience, but will also provide much-needed stability for new programs and may ease state concerns about updating Medicaid policies to cover these services.</p><h2>Background</h2><p>To receive approval to participate in the H@H program, hospitals must submit an individual waiver request to CMS. The request specifically asks CMS to waive §422.23(b) and (b)(1) of the Medicare Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, seven days a week, as well as the immediate availability of a registered nurse for the care of any patient. Once the waiver request is received, CMS divides the applications into two categories, allowing more-experienced hospitals a quicker approval process so they can rapidly expand their H@H program; less-experienced hospitals must demonstrate they can meet the requirements associated with the provision of H@H services.</p><p>As of July 2025, 400 hospitals across 142 systems and 39 states have been approved to provide H@H services to patients. Other health systems and hospitals have indicated they are interested in standing up H@H programs but are hesitant to do so without a long-term extension from Congress.</p><p>In October 2024, CMS released a report adding to the growing body of literature demonstrating that H@H is a safe, effective program. CMS found that H@H patients generally had lower mortality rates, readmission rates and spending in the 30 days post-discharge. Patients and caregivers also expressed predominantly positive experiences with the program. While the report found that H@H patients were more likely to be white and live in an urban location and less likely to receive Medicaid or low-income subsidies, this can in part be attributed to the variability in state Medicaid coverage of H@H programs. As of June 2024, only 12 states provide Medicaid coverage for H@H.</p></div><div class="col-md-4"><a href="/system/files/media/file/2024/07/Fact-Sheet-Extending-the-Hospital-at-Home-Program-20240719.pdf"><img src="/sites/default/files/2025-04/fact-sheet-extending-the-hospital-at-home-program-april-2025.png" data-entity-uuid data-entity-type="file" alt="Fact Sheet Image" width="682" height="882"></a><p> </p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2024/08/understanding-the-hospital-at-home-program-infographic.pdf" target="_blank" title="Click here to download the Infographic: Understanding the Hospital At Home Program PDF.">Download the Infographic PDF</a></div><p><a href="/system/files/media/file/2024/08/understanding-the-hospital-at-home-program-infographic.pdf" target="_blank" title="Click here to download the Infographic: Understanding the Hospital At Home Program PDF."><img src="/sites/default/files/inline-images/Infographic-Understanding-the-Hospital-at-Home-Program.png" data-entity-uuid="ebd70ee9-b007-40de-8c11-c2330a37ff3b" data-entity-type="file" alt="Infographic: Understanding the Hospital at Home Program." width="582" height="900"></a></p></div></div></div> h2 { color:#003087; } Thu, 24 Jul 2025 12:00:00 -0500 Fact Sheets /fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program <div class="container"><div class="row"><div class="col-md-8">h2 { color:#003087; } .meta.custom-lock-position { position: relative; top: 0px; right: inherit; display: block; float: right; } <h2>The Issue</h2><p>The Medicaid Disproportionate Share Hospital (DSH) program provides essential financial assistance to hospitals that care for our nation’s most vulnerable populations, including children and those who are disabled and elderly. These hospitals also provide critical community services, such as trauma and burn care, maternal and child health, high-risk neonatal care and disaster preparedness resources. Congress reduced Medicaid DSH payments in the Affordable Care Act, reasoning that hospitals would care for fewer uninsured patients as health coverage expanded. However, those coverage increases have not yet been fully realized. In addition, the Medicaid program continues to face challenges, as states will likely make policy changes to their programs in advance of the implementation of provisions related to the One Big Beautiful Bill Act (OBBBA). Many Medicaid stakeholders are concerned that millions of eligible individuals will lose access to coverage in the coming years.</p><h2>AHA Position</h2><p>Congress should provide relief from the Medicaid DSH cuts given the vital need for the program.</p><h2>Why?</h2><ul><li>The Medicaid DSH program, since its inception in the early 1980s, provides vital financial support to hospitals that serve the nation’s most vulnerable populations. This includes children, pregnant women, older adults, veterans, and other low- income patients with Medicaid coverage, and the uninsured.</li><li>Even with this critical supplemental funding, hospital costs for providing care to vulnerable populations are not fully met. In 2023, the difference between Medicaid payments to hospitals and costs incurred for treating beneficiaries, known as “Medicaid shortfall,” was $27.5 billion. Hospitals have historically relied on non-DSH supplemental payments, including state directed payments (SDPs), to help address the Medicaid underpayments. Recent limits imposed on SDPs through the OBBBA will drastically reduce funding from this critical hospital payment mechanism and compound the impact of DSH cuts. Now is not the time for additional cuts to funding when many hospitals are facing financial hardship.</li><li>The need for DSH payments continues. Tens of millions of Americans <a href="https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202506.pdf" target="_blank" title="CDC: Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2024 PDF">currently</a> do not have health insurance, and Congressional Budget Office said that the uninsured rate will continue to rise over the next decade, including due to implementation of the OBBBA.</li></ul><h2>Key Facts</h2><p>The Medicaid DSH cut for fiscal year (FY) 2026 is $8 billion and will go into effect on Oct. 1, 2025, unless Congress acts. The program is scheduled to be reduced by another $8 billion for each of the next two FYs 2027-2028 ($24 billion total over the next three fiscal years). The Medicaid and CHIP Payment and Access Commission in its final report to Congress on the <a href="https://www.macpac.gov/wp-content/uploads/2024/03/Chapter-3-Annual-Analysis-of-Medicaid-Disproportionate-Share-Hospital-Allotments-to-States.pdf" target="_blank" title="MACPAC: Annual Analysis of Medicaid Disproportionate Share Hospital Allotments to States">Annual Analysis of Medicaid Disproportionate Share Hospital Allotments to States</a> provides information on the DSH allotment reductions by state (Table 3A-2). The need for Medicaid DSH supplemental funding remains essential as hospitals cope with the impacts of financial instability while supporting their mission to treat all patients, regardless of ability to pay.</p></div><div class="col-md-4"><p><a href="/system/files/media/file/2020/02/fact-sheet-medicaid-dsh-0120.pdf" target="_blank" title="Click here to download the Fact Sheet: Medicaid DSH Program PDF."><img src="/sites/default/files/2025-04/fact-sheet-medicaid-dsh-program-april-2025.png" data-entity-uuid data-entity-type="file" alt="Fact Sheet: Medicaid DSH Program cover. Updated April 2025." width="695" height="899"></a></p><hr><p><div class="views-element-container"> <section class="top-level-view js-view-dom-id-619743a8f60d7cf62a594ae3f0b77e0c7865d0fcfcb4cb72fa168935e9658b3d resource-block"> <h3>Latest Medicaid DSH Payment Cuts Advocacy and News</h3> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member-non-fed" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/280" hreflang="en">Member Non-Fed</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/action-alert/2025-07-28-take-action-engage-lawmakers-august-build-support-key-priorities" hreflang="en">TAKE ACTION: Engage Lawmakers in August to Build Support for Key Priorities</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T15:43:12-05:00">Jul 28, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/news/chairpersons-file/2025-07-28-chair-file-obbba-and-whats-next-health-care" hreflang="en">Chair File: The OBBBA and What’s Next for Health Care</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-28T10:16:20-05:00">Jul 28, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-public" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/278" hreflang="en">Public</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/fact-sheets/2023-03-28-fact-sheet-medicaid-dsh-program" hreflang="en">Fact Sheet: Medicaid DSH Program </a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-07-24T08:00:00-05:00">Jul 24, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member-non-fed" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/280" hreflang="en">Member Non-Fed</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/action-alert/2025-02-07-contact-your-lawmakers-and-urge-them-extend-key-health-care-policies-set-expire-next-month" hreflang="en">Contact Your Lawmakers and Urge Them to Extend Key Health Care Policies Set to Expire Next Month</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2025-02-07T15:04:02-06:00">Feb 7, 2025</time> </span> </div></div> <div class="article views-row"> <div class="views-field views-field-field-access-level"> <div class="field-content"> <div class="meta custom-lock-position"> <div class="views-field-access-level access-type-member" data-toggle="tooltip" data-placement="bottom" title="Members only"><a href="/taxonomy/term/279" hreflang="en">Member</a></div> </div></div> </div><div class="views-field views-field-title"> <span class="field-content"><a href="/special-bulletin/2024-12-21-congress-passes-bill-funding-government-current-levels-march-extending-key-health-care-provisions" hreflang="en">Congress Passes Bill Funding Government at Current Levels into March, Extending Key Health Care Provisions to Expire</a></span> </div><div class="views-field views-field-created"> <span class="field-content"><time datetime="2024-12-21T09:54:45-06:00">Dec 21, 2024</time> </span> </div></div> </div> </div> <div class="more-link"><a href="/topics/medicaid-dsh">More on Medicaid DSH</a></div> </section> </div> </p></div></div></div> Thu, 24 Jul 2025 08:00:00 -0500 Fact Sheets /fact-sheets/2025-02-07-fact-sheet-enhanced-premium-tax-credits <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>The federal government offers enhanced premium tax credits (EPTCs or tax credits) to help some individuals and families purchase insurance on the health insurance marketplaces. Eligibility and tax credit amounts are based on the individual or family’s income level, as well as their access to other forms of comprehensive coverage, e.g., through their employer.</p><p>In 2021, Congress increased and expanded eligibility for the tax credits; however, those policies are scheduled to expire at the end of 2025. These 2021 tax credits have resulted in an additional 10 million people gaining coverage through the health insurance marketplaces while others receiving assistance paying their health insurance costs.<a href="#fn1"><sup>1</sup></a> This has increased access to health care coverage and high quality care for patients and communities served by hospitals, health systems and other providers.</p><h2>AHA Take</h2><p>In support of the health of our patients and communities, as well as the stability of the entire health care system, the AHA urges Congress to extend the enhanced premium tax credits.</p><h2>Why?</h2><ul><li>The tax credits helped millions of Americans purchase affordable commercial health care coverage. <span><strong>The expiration of this policy would effectively be a tax increase of $700 on average for millions of people across the nation.</strong></span></li><li>The expiration of the enhanced tax credits will result in 4.2 million people becoming uninsured by 2034.<a href="#fn2"><sup>2</sup></a> There would be a disproportionate impact to those in rural states and those with lower incomes.</li><li>Some states would see higher rates of disruption in coverage and loss of federal tax funds, particularly those that have not expanded Medicaid. Several of these states, such as Texas and Florida, experienced some of the highest enrollment growth in the health insurance marketplaces due to the enhanced tax credits.</li><li>The loss of coverage would put considerable financial stress on hospitals, health systems and other providers, which will face more uncompensated care and bad devbt. This, in turn, would make it difficult for them to maintain services in their communities KNG Health Consulting found that <span><strong>allowing the EPTCs to expire would result in a $28 billion reduction in hospital spending over 10 years.</strong></span></li></ul><h2>Background</h2><p>Certain individuals and families are eligible for prospective, monthly tax credits that lower the cost of health insurance marketplace premiums. To be eligible, these individuals or families must:</p><ul><li>Meet certain income thresholds, based on the federal poverty level (FPL).<a href="#fn3"><sup>3</sup></a></li><li>Not be eligible for other comprehensive coverage, including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), or affordable employer-sponsored coverage (defined as costing less than 8.5% of household income).<a href="#fn4"><sup>4</sup></a></li><li>Be a U.S. citizen or have proof of legal residency or, as of Jan. 1, 2025, be eligible for Deferred Action for Childhood Arrivals.</li><li>If married, file taxes jointly.</li></ul><p>The amount of tax credit that an individual or family is eligible for is based on household income, as well as the cost of the second-lowest silver plan in the individual’s market. Once an individual or family has been determined eligible and selected their preferred health plan, the tax credit is immediately applied directly to the premium; thus, the enrollee only needs to pay the remaining amount.</p><hr><ol><li id="fn1"><a href="https://www.kff.org/affordable-care-act/issue-brief/a-look-at-aca-coverage-through-the-marketplaces-and-medicaid-expansion-ahead-of-potential-policy-changes">kff.org/affordable-care-act/issue-brief/a-look-at-aca-coverage-through-the-marketplaces-and-medicaid-expansion-ahead-of-potential-policy-changes</a></li><li id="fn2"><a href="https://www.cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf" target="_blank">cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf</a></li><li id="fn3">The income used to calculate the EPTCs is an estimate by the applicant based on what they expect their household income to be in the coming year. When filing taxes at the end of the year, they may receive additional tax credits if their income was lower than expected. Alternatively, they may have to repay some of their tax credit if their income was higher than expected.</li><li id="fn4">For employer-sponsored coverage to be considered affordable, it must meet a minimum value requirement, and the annual premium must be equal to or less than 9.02% of the individual’s household income.</li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/Fact-Sheet-Enhanced-Premium-Tax-Credits-20250207.pdf" target="_blank" title="Click here to download the Fact Sheet: Enhanced Premium Tax Credits PDF."><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Enhanced-Premium-Tax-Credits-20250723.png" data-entity-uuid="40c5157b-ccee-415d-9b67-bf570f30f3f7" data-entity-type="file" alt="Fact Sheet: Enhanced Premium Tax Credits page 1." width="695" height="900"></a></div></div></div> h2 { color: #003087; } Wed, 23 Jul 2025 10:38:20 -0500 Fact Sheets /fact-sheets/2025-06-29-estimated-impact-fmap-reduction <div class="container"><div class="row"><div class="col-md-8"><p>The table below summarizes the 10-year impact on federal Medicaid hospital spending if the Federal Medical Assistance Percentage (FMAP) were reduced to the traditional level for Medicaid expansion enrollees due to program churn.</p><table><thead><tr><th>State</th><th>10-year Reduction in Federal Medicaid Hospital Spending<br>(FYs 2026-2035)</th></tr></thead><tbody><tr class="red-row"><td class="red-row">United States</td><td class="red-row">-$198.3B</td></tr><tr><td>Alabama</td><td>-$0B</td></tr><tr><td>Alaska</td><td>-$343M</td></tr><tr><td>Arizona</td><td>-$6.7B<a href="#fn1">*</a></td></tr><tr><td>Arkansas</td><td>-$1.2B<a href="#fn1">*</a></td></tr><tr><td>California</td><td>-$53.5B</td></tr><tr><td>Colorado</td><td>-$2.5B</td></tr><tr><td>Connecticut</td><td>-$2.8B</td></tr><tr><td>Delaware</td><td>-$512M</td></tr><tr><td>DC</td><td>-$494M</td></tr><tr><td>Florida</td><td>-$0B</td></tr><tr><td>Georgia</td><td>-$0B</td></tr><tr><td>Hawaii</td><td>-$819M</td></tr><tr><td>Idaho</td><td>-$447M<a href="#fn1">*</a></td></tr><tr><td>Illinois</td><td>-$11.0B<a href="#fn1">*</a></td></tr><tr><td>Indiana</td><td>-$2.8B<a href="#fn1">*</a></td></tr><tr><td>Iowa</td><td>-$2.0B<a href="#fn1">*</a></td></tr><tr><td>Kansas</td><td>-$0B</td></tr><tr><td>Kentucky</td><td>-$4.4B</td></tr><tr><td>Louisiana</td><td>-$4.7B</td></tr><tr><td>Maine</td><td>-$605M</td></tr><tr><td>Maryland</td><td>-$3.6B</td></tr><tr><td>Massachusetts</td><td>-$4.3B</td></tr><tr><td>Michigan</td><td>-$6.0B</td></tr><tr><td>Minnesota</td><td>-$2.9B</td></tr><tr><td>Mississippi</td><td>-$0B</td></tr><tr><td>Missouri</td><td>-$2.3B</td></tr><tr><td>Montana</td><td>-$809M<a href="#fn1">*</a></td></tr><tr><td>Nebraska</td><td>-$581M</td></tr><tr><td>Nevada</td><td>-$3.0B</td></tr><tr><td>New Hampshire</td><td>-$350M<a href="#fn1">*</a></td></tr><tr><td>New Jersey</td><td>-$7.6B</td></tr><tr><td>New Mexico</td><td>-$1.6B<a href="#fn1">*</a></td></tr><tr><td>New York</td><td>-$15.3B</td></tr><tr><td>North Carolina</td><td>-$8.9B<a href="#fn1">*</a></td></tr><tr><td>North Dakota</td><td>-$248M</td></tr><tr><td>Ohio</td><td>-$5.0B</td></tr><tr><td>Oklahoma</td><td>-$2.8B</td></tr><tr><td>Oregon</td><td>-$4.8B</td></tr><tr><td>Pennsylvania</td><td>-$7.3B</td></tr><tr><td>Rhode Island</td><td>-$634M</td></tr><tr><td>South Carolina</td><td>-$0B</td></tr><tr><td>South Dakota</td><td>-$228M</td></tr><tr><td>Tennessee</td><td>-$0B</td></tr><tr><td>Texas</td><td>-$0B</td></tr><tr><td>Utah</td><td>-$873M<a href="#fn1">*</a></td></tr><tr><td>Vermont</td><td>-$208M</td></tr><tr><td>Virginia</td><td>-$15.2B<a href="#fn1">*</a></td></tr><tr><td>Washington</td><td>-$8.6B</td></tr><tr><td>West Virginia</td><td>-$513M</td></tr><tr><td>Wisconsin</td><td>-$0B</td></tr><tr><td>Wyoming</td><td>-$0B</td></tr></tbody></table><p><strong>Source:</strong> AHA analysis of modeling conducted by Manatt Health Strategies, LLC.</p><p> </p><hr><h2>Notes</h2><p id="fn1">*12 states have trigger laws in place that would automatically end Medicaid expansion or require program changes if their FMAP is reduced from 90%. The impact for these 12 states is likely to be significantly larger if they end or limit Medicaid expansion.</p><p>This analysis reflects the reduction in federal Medicaid hospital spending from a churn-based FMAP reduction. It does not account for potential changes in state Medicaid hospital spending that may occur. Our estimates show the midpoint between historical Medicaid enrollment churn levels of 10% per year and 100% conversion of all expansion-eligible adults to regular FMAP.</p></div><div class="col-md-4"><div class="sticky"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional.pdf" target="_blank" title="Click here to download the Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet PDF.">Download the Fact Sheet PDF</a></div><a href="/system/files/media/file/2025/06/Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional.pdf" target="_blank" title="Click here to download the Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet PDF."><img src="/sites/default/files/inline-images/Page-1-Estimated-Impact-of-FMAP-Reduction-from-90%25-to-Traditional-900x695.png" data-entity-uuid="4a30cd4c-7769-4dad-87a3-1d94be0bb591" data-entity-type="file" alt="Estimated Impact of FMAP Reduction (from 90% to Traditional) as a Result of Churn on Federal Medicaid Hospital Spending fact sheet page 1." width="695" height="900"></a></div></div></div></div> table, th, td { border: 1px solid; } th { background-color: #003087; color: #ffffff; } .red-row { background-color: #9d2235; color: #ffffff; font-style: italic; } div.sticky { position: sticky; top: 0; } Sun, 29 Jun 2025 14:48:02 -0500 Fact Sheets /fact-sheets/2025-06-13-rural-hospitals-risk-cuts-medicaid-would-further-threaten-access <div class="container"><div class="row"><div class="col-md-8"><p>Medicaid, which covers over 16 million people in rural communities, helps address barriers to health care and sustain rural hospitals. But many in Congress are considering Medicaid cuts that would have a devastating impact on rural hospitals and patients.</p><p><span><strong>The One Big Beautiful Bill Act (H.R. 1) would result in 1.8 million individuals in rural communities losing their Medicaid coverage by 2034. In addition, select Medicaid provisions in H.R. 1 would result in a $50.4 billion reduction in federal Medicaid spending on rural hospitals over 10 years.</strong></span><a href="#fn1"><sup>1</sup></a> See the chart on the next page for a state-by-state breakdown of rural spending and coverage losses.</p><h2>Rural Hospitals Are Already Struggling:</h2><ul class="red"><li class="red"><span><strong>48%</strong></span> of rural hospitals operated at a financial loss in 2023.<a href="#fn2"><sup>2</sup></a></li><li class="red"><span><strong>92</strong></span> rural hospitals have closed their doors or been unable to continue providing inpatient services over the past 10 years.<a href="#fn3"><sup>3</sup></a></li><li class="red">Rural hospitals lose money on several <span><strong>critical service lines</strong></span>, including behavioral health, pulmonology, obstetrics, and burns and wounds.<a href="#fn4"><sup>4</sup></a></li></ul><h2>Medicaid is Critical to Rural Hospitals:</h2><ul class="red"><li class="red"><span><strong>16.1 million</strong></span> people living in rural communities are covered by Medicaid.<a href="#fn5"><sup>5</sup></a></li><li class="red">In nine states, <span><strong>over 50%</strong></span> of the Medicaid population lives in rural communities: Montana, South Dakota, Wyoming, Mississippi, Vermont, Kentucky, North Dakota, Alaska and Maine.<a href="#fn6"><sup>6</sup></a></li><li class="red"><span><strong>47%</strong></span> of rural births in the U.S. are covered by Medicaid.<a href="#fn7"><sup>7</sup></a></li><li class="red"><span><strong>65%</strong></span> of nursing home residents in rural counties are covered by Medicaid.<a href="#fn8"><sup>8</sup></a></li></ul><h2>Medicaid Already Pays Rural Hospitals Far Less Than the Cost of Care:</h2><ul class="red"><li class="red">Medicaid paid rural hospitals <span><strong>approximately 63 cents on the dollar</strong></span> for inpatient obstetrics care in 2024.<a href="#fn9"><sup>9</sup></a><ul class="red"><li class="red">There has been a <span><strong>16%</strong></span> decline in rural counties with hospital-based obstetric care services over the last decade.<a href="#fn10"><sup>10</sup></a></li></ul></li><li class="red">Similarly, Medicaid payments covered approximately just <span><strong>70%</strong></span> of costs for behavioral health services in hospital settings, which include substance use disorder treatment.<a href="#fn11"><sup>11</sup></a></li></ul><hr><table><thead><tr><th>State</th><th>10-Year Rural Medicaid Coverage Loss Through 2034</th><th>10-Year Federal Rural Hospital Impact Through 2034</th></tr></thead><tbody><tr><td>United States</td><td>-1.8M</td><td>-$50.4B</td></tr><tr><td>Alabama</td><td>-15.4K</td><td>-$265M</td></tr><tr><td>Alaska</td><td>-17.2K</td><td>-$382M</td></tr><tr><td>Arizona</td><td>-41.1K</td><td>-$905M</td></tr><tr><td>Arkansas</td><td>-51.1K</td><td>-$1,109M</td></tr><tr><td>California</td><td>-134.9K</td><td>-$2,057M</td></tr><tr><td>Colorado</td><td>-28.4K</td><td>-$835M</td></tr><tr><td>Connecticut</td><td>-8.0K</td><td>-$135M</td></tr><tr><td>Delaware</td><td>-6.5K</td><td>-$174M</td></tr><tr><td>District of Columbia</td><td>0K</td><td>$0M</td></tr><tr><td>Florida</td><td>-7.9K</td><td>-$210M</td></tr><tr><td>Georgia</td><td>-17.6K</td><td>-$540M</td></tr><tr><td>Hawaii</td><td>-24.9K</td><td>-$507M</td></tr><tr><td>Idaho</td><td>-17.2K</td><td>-$362M</td></tr><tr><td>Illinois</td><td>-53.8K</td><td>-$2,014M</td></tr><tr><td>Indiana</td><td>-64.6K</td><td>-$1,139M</td></tr><tr><td>Iowa</td><td>-37.7K</td><td>-$2,666M</td></tr><tr><td>Kansas</td><td>-5.3K</td><td>-$306M</td></tr><tr><td>Kentucky</td><td>-142.3K</td><td>-$4,012M</td></tr><tr><td>Louisiana</td><td>-79.0K</td><td>-$1,875M</td></tr><tr><td>Maine</td><td>-32.7K</td><td>-$640M</td></tr><tr><td>Maryland</td><td>-8.6K</td><td>-$267M</td></tr><tr><td>Massachusetts</td><td>-6.3K</td><td>-$81M</td></tr><tr><td>Michigan</td><td>-68.2K</td><td>-$2,008M</td></tr><tr><td>Minnesota</td><td>-36.2K</td><td>-$1,065M</td></tr><tr><td>Mississippi</td><td>-19.3K</td><td>-$1,529M</td></tr><tr><td>Missouri</td><td>-51.4K</td><td>-$1,522M</td></tr><tr><td>Montana</td><td>-22.3K</td><td>-$1,076M</td></tr><tr><td>Nebraska</td><td>-13.2K</td><td>-$375M</td></tr><tr><td>Nevada</td><td>-10.1K</td><td>-$230M</td></tr><tr><td>New Hampshire</td><td>-12.6K</td><td>-$753M</td></tr><tr><td>New Jersey</td><td>-5.7K</td><td>$0M</td></tr><tr><td>New Mexico</td><td>-55.2K</td><td>-$1,380M</td></tr><tr><td>New York</td><td>-70.9K</td><td>-$1,125M</td></tr><tr><td>North Carolina</td><td>-82.0K</td><td>-$2,988M</td></tr><tr><td>North Dakota</td><td>-7.0K</td><td>-$61M</td></tr><tr><td>Ohio</td><td>-86.0K</td><td>-$2,497M</td></tr><tr><td>Oklahoma</td><td>-51.1K</td><td>-$2,372M</td></tr><tr><td>Oregon</td><td>-83.6K</td><td>-$1,979M</td></tr><tr><td>Pennsylvania</td><td>-55.0K</td><td>-$1,131M</td></tr><tr><td>Rhode Island</td><td>0K</td><td>$0M</td></tr><tr><td>South Carolina</td><td>-5.1K</td><td>-$410M</td></tr><tr><td>South Dakota</td><td>-12.2K</td><td>-$95M</td></tr><tr><td>Tennessee</td><td>-16.3K</td><td>-$726M</td></tr><tr><td>Texas</td><td>-19.9K</td><td>-$1,047M</td></tr><tr><td>Utah</td><td>-7.4K</td><td>-$327M</td></tr><tr><td>Vermont</td><td>-11.3K</td><td>-$233M</td></tr><tr><td>Virginia</td><td>-55.5K</td><td>-$1,655M</td></tr><tr><td>Washington</td><td>-49.3K</td><td>-$1,997M</td></tr><tr><td>West Virginia</td><td>-30.0K</td><td>-$664M</td></tr><tr><td>Wisconsin</td><td>-30.1K</td><td>-$607M</td></tr><tr><td>Wyoming</td><td>-1.6K</td><td>-$33M</td></tr></tbody></table><p><span><strong>Source:</strong></span> Modeling of select H.R. 1 Medicaid provisions conducted by Manatt Health Strategies, LLC. This analysis accounts for the following H.R. 1 Medicaid provisions: (1) mandatory community engagement (work) requirements, (2) increasing frequency of eligibility redeterminations for certain individuals, (3) ban on new or increased provider taxes, (4) revising the payment limit for state directed payments (SDPs), (5) reduction in the expansion FMAP in states providing coverage to certain undocumented immigrants and (6) the repeal of rules relating to eligibility and enrollment in Medicaid, CHIP, the Medicare Savings Programs (MSPs) and the Basic Health Program (BHP).</p><p><span><strong>Notes:</strong></span> State values will not sum to national totals due to rounding. Rural Medicaid coverage losses are based on the geographical distribution of Medicaid enrollees. Rural hospital impacts are based on the geographical distribution of Medicaid hospital expenditures.</p><hr><h3>End Notes</h3><ol class="redol"><li class="redol" id="fn1">Modeling of select H.R. 1 Medicaid provisions conducted by Manatt Health Strategies, LLC. This analysis accounts for the following H.R. 1 Medicaid provisions: (1) mandatory community engagement (work) requirements, (2) increasing frequency of eligibility redeterminations for certain individuals, (3) ban on new or increased provider taxes, (4) revising the payment limit for state directed payments (SDPs), (5) reduction in the expansion FMAP in states providing coverage to certain undocumented immigrants and (6) the repeal of rules relating to eligibility and enrollment in Medicaid, CHIP, the Medicare Savings Programs (MSPs) and the Basic Health Program (BHP).</li><li class="redol" id="fn2">AHA analysis of RAND Hospital Cost Report data.</li><li class="redol" id="fn3">AHA analysis of data from Cecil G. Sheps Center for Health Services Research.</li><li class="redol" id="fn4">AHA analysis of industry benchmark data from Strata Decision Technology LLC.</li><li class="redol" id="fn5">Kaiser Family Foundation (KFF).</li><li class="redol" id="fn6">KFF.</li><li class="redol" id="fn7">AHA analysis of data from CDC Wonder.</li><li class="redol" id="fn8">Rural Policy Research Institute.</li><li class="redol" id="fn9">AHA analysis of industry benchmark data from Strata Decision Technology LLC.</li><li class="redol" id="fn10">University of Minnesota Rural Health Research Center.</li><li class="redol" id="fn11">AHA analysis of industry benchmark data from Strata Decision Technology LLC.</li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Rural-Hospitals-at-Risk-Cuts-to-Medicaid-Would-Further-Threaten-Access.pdf" target="_blank" title="Click here to download the Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access fact sheet PDF.">Download the Fact Sheet PDF</a></div><a href="/system/files/media/file/2025/06/Rural-Hospitals-at-Risk-Cuts-to-Medicaid-Would-Further-Threaten-Access.pdf" target="_blank" title="Click here to download the Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access fact sheet PDF."><img src="/sites/default/files/inline-images/Page-1-Rural-Hospitals-at-Risk-Cuts-to-Medicaid-Would-Further-Threaten-Access.png" data-entity-uuid="6f149817-91d2-41db-87af-39570c6b7b4f" data-entity-type="file" alt="Rural Hospitals at Risk: Cuts to Medicaid Would Further Threaten Access fact sheet page 1." width="695" height="900"></a><p><div class="views-element-container"> <section class="top-level-view js-view-dom-id-aa7bc6c6489e01047c0e4f4483bf1f5ef3259e39c66321b42f1b96507b23ce57 resource-block"> <h3>Related Podcasts</h3> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2025-07-16-behind-bill-what-one-big-beautiful-bill-act-means-hospitals-and-health-systems" hreflang="en">Behind the Bill: What the One Big Beautiful Bill Act Means for Hospitals and Health Systems</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2025-07-02-when-medicaid-disappears-how-cuts-could-devastate-behavioral-health-care-rural-america" hreflang="en">When Medicaid Disappears: How Cuts Could Devastate Behavioral Health Care in Rural America</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health 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href="/advocacy/advocacy-issues/medicaid" title="Click to visit AHA Medicaid Advocacy Issue page">Advocacy Issue: Medicaid</a></p></div></div></div></div> ul.red { list-style: none; } ul.red li.red::before { content: "\2022"; color: #9d2235; font-weight: bold; display: inline-block; width: 1em; margin-left: -1em; } ol.redol li.redol::marker { color: #9d2235; font-weight: bold; } h2 { color: #003087; } h3 { color: #9d2235; } table, th, td { border: 1px solid; } th { color: #ffffff; background-color: #003087; } Mon, 16 Jun 2025 00:00:00 -0500 Fact Sheets /fact-sheets/2025-06-05-fact-sheet-one-big-beautiful-bill-act-would-significantly-reduce-availability-coverage-health-insurance <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p><span><strong>The House-passed One Big Beautiful Bill Act (OBBBA, H.R. 1) makes significant changes to the Affordable Care Act (ACA) marketplaces that would lead to millions of people losing their coverage and becoming uninsured.</strong></span> These policies would make it more challenging for individuals to enroll and could result in higher premiums by reducing the amount of available tax credits. As a result, the Congressional Budget Office estimates that at least 3 million current marketplace enrollees would lose coverage.<a href="#fn1"><sup>1</sup></a> These coverage losses would be in addition to the estimated coverage losses due to the expiration of the enhanced premium tax credits.</p><h2>AHA Take</h2><p>The marketplaces are a vital piece of the U.S. health insurance coverage framework, providing access to quality health care for millions of Americans. When individuals lose health insurance coverage, they ultimately turn to their local hospital when they need care. This affects everyone, not only the uninsured, leading to overcrowded emergency departments, longer wait times and increased costs for care, which acts as a “hidden tax” on all. <span><strong>The AHA urges the Senate to reject the changes to the marketplaces in the House bill that will result in millions of people becoming uninsured.</strong></span></p><h2>Background</h2><p>For more than a decade, tens of millions of Americans who do not have access to affordable coverage through their employer or a government program (e.g., Medicare, Medicaid) have relied on the marketplaces to access comprehensive coverage. Marketplace enrollees are often small business owners, self-employed or those with multiple part-time jobs or jobs that pay hourly. Nearly three out of four enrollees have incomes that are between 100-250% of the Federal Poverty Level.<a href="#fn2"><sup>2</sup></a><sup>,</sup><a href="#fn3"><sup>3</sup></a></p><p>In 2025, over 24 million people enrolled in coverage through the marketplaces. Over 90% of those enrollees receive federal tax credits that lower their monthly premiums for marketplace coverage, with amounts based on their income.<a href="#fn4"><sup>4</sup></a> In 2021, Congress established enhanced tax credits by increasing and expanding eligibility; however, those policies are scheduled to expire at the end of 2025.<a href="#fn5"><sup>5</sup></a></p><h2>One Big Beautiful Bill Marketplace Provisions</h2><p>The OBBBA includes many provisions that, when taken together, will result in over 3 million marketplace enrollees becoming uninsured. Notably, the bill:</p><ul class="red"><li class="red"><span><strong>Eliminates automatic reenrollment for individuals receiving premium tax credits by requiring annual re-verification of tax credit eligibility.</strong></span> Nearly 11 million people enrolled through automatic, or passive, reenrollment in 2025, which is over half of all returning enrollees.<a href="#fn6"><sup>6</sup></a> Currently, the marketplaces use prior information from the enrollees’ original application along with updated tax data acquired through an automated process to complete reenrollment and updated tax credit eligibility verification without the returning enrollee submitting updated information or paperwork. Under the OBBBA, enrollees would be required to submit updated information on an annual basis to receive tax credits, resulting in a new administrative burden for enrollees and significantly higher premiums for those who fail to reenroll promptly.</li><li class="red"><span><strong>Eliminates provisional eligibility for premium tax credits while applicants are awaiting eligibility determinations.</strong></span> This would require Marketplace enrollees to pay the full, unsubsidized premiums for weeks or months while their applications are being verified.</li><li class="red"><span><strong>Removes the cap on the amount of tax credits that enrollees must repay to the government if their income changes during the year.</strong></span> Tax credit amounts are based on income expectations for the enrollment period. Currently, if an enrollee receives excess premium tax credits due to their actual income exceeding their expectations, they must repay the excess during the tax filing process. For most enrollees, there is a repayment cap based on household income. Under the OBBBA, all premium tax credit recipients would be required to pay the full amount of the excess, regardless of their income. This would add additional financial risk to subsidized enrollees who often experience unpredictable incomes, especially those with the lowest incomes.<a href="#fn7"><sup>7</sup></a></li><li class="red"><span><strong>Shortens the annual open enrollment period.</strong></span> Currently, open enrollment periods for federally facilitated marketplaces run from Nov. 1-Jan. 15 and state-based marketplaces have the flexibility to extend open enrollment beyond that window. The OBBBA would shorten the open enrollment period to Nov. 1-Dec. 15 for all marketplaces. In 2025, roughly 40% of enrollees enrolled after Dec. 15.<a href="#fn8"><sup>8</sup></a></li><li class="red"><span><strong>Ends the monthly low-income special enrollment period and state-based marketplaces’ special enrollment periods based on income.</strong></span> Income-based special enrollment periods offer lower-income people additional opportunities to enroll in health insurance coverage throughout the year. Losing these enrollment opportunities is particularly problematic when coupled with other OBBBA provisions that add barriers to enrollment through more burdensome eligibility and enrollment processes.</li><li class="red"><span><strong>Imposes new administrative burden on enrollees</strong></span> by adding additional income verification processes for individuals with incomes between 100-400% of the Federal Poverty Level.</li><li class="red"><span><strong>Funds the cost-sharing reduction payments,</strong></span> which will result in less generous tax credit amounts and increased premiums for subsidized enrollees. This policy will be challenging for insurers to implement beginning in 2026, potentially resulting in insurers exiting the markets.</li></ul><p><span><strong>Additionally, the bill does not extend the marketplace enhanced premium tax credits</strong></span><strong>.</strong> These tax credits have enabled millions of additional low and middle-income working individuals and families to purchase affordable health care coverage through the marketplaces. The expiration of these credits would effectively be a tax increase of $700 on average for millions of people across the nation and result in an additional 4.2 million people becoming uninsured.<a href="#fn9"><sup>9</sup></a></p><p><span><strong>Taken together, the cumulative impact of the changes to the ACA marketplaces in the OBBBA and the expiration of the enhanced premium tax credits would result in nearly one-third of all current marketplace enrollees losing access to affordable health care coverage.</strong></span> In addition, these policies are likely to destabilize the marketplaces, reducing access to health insurance coverage and increasing the number of uninsured and the amount of uncompensated care provided by hospitals.</p><hr><h3>End Notes</h3><ol class="fnred"><li class="fnred" id="fn1"><a href="https://www.cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf" target="_blank">cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf</a></li><li class="fnred" id="fn2"><a href="https://www.cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf" target="_blank">cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf</a></li><li class="fnred" id="fn3">In 2025, this equals $15,650-$39,125 per year for an individual and $32,150-$80,375 for a family of four.</li><li class="fnred" id="fn4"><a href="https://www.cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf" target="_blank">cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf</a></li><li class="fnred" id="fn5"><a href="/system/files/media/file/2025/02/Fact-Sheet-Enhanced-Premium-Tax-Credits-20250207.pdf" target="_blank">aha.org/system/files/media/file/2025/02/Fact-Sheet-Enhanced-Premium-Tax-Credits-20250207.pdf</a></li><li class="fnred" id="fn6"><a href="https://www.cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf" target="_blank">cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf</a></li><li class="fnred" id="fn7"><a href="https://www.kff.org/affordable-care-act/issue-brief/marketplace-enrollees-with-unpredictable-incomes-could-face-bigger-penalties-under-house-reconciliation-bill-provision/" target="_blank">kff.org/affordable-care-act/issue-brief/marketplace-enrollees-with-unpredictable-incomes-could-face-bigger-penalties-under-house-reconciliation-bill-provision/</a></li><li class="fnred" id="fn8"><a href="https://www.cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf" target="_blank">cms.gov/files/document/health-insurance-exchanges-2025-open-enrollment-report.pdf</a></li><li class="fnred" id="fn9"><a href="https://www.cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf" target="_blank">cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf</a></li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Fact-Sheet-One-Big-Beautiful-Bill-Act-Would-Significantly-Reduce-Availability-of-Coverage.pdf" target="_blank" title="Click here to download the Fact Sheet: One Big Beautiful Bill Act Would Significantly Reduce Availability of Coverage in the Health Insurance Marketplaces PDF.">Download the Fact Sheet PDF</a></div><a href="/system/files/media/file/2025/06/Fact-Sheet-One-Big-Beautiful-Bill-Act-Would-Significantly-Reduce-Availability-of-Coverage.pdf"><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-One-Big-Beautiful-Bill-Act-Would-Significantly-Reduce-Availability-of-Coverage.png" data-entity-uuid="364043ab-7de4-4b4a-9051-03b3f18fc7a8" data-entity-type="file" alt="Fact Sheet: One Big Beautiful Bill Act Would Significantly Reduce Availability of Coverage in the Health Insurance Marketplaces page 1." width="695" height="900"></a></div></div></div> h2 { color: #003087; } h3 { color: #9d2235; } ul.red li.red::marker { color: #9d2235; font-weight: bold; } ol.fnred li.fnred::marker { color: #9d2235; font-weight: bold; } Thu, 05 Jun 2025 13:09:04 -0500 Fact Sheets /fact-sheets/2025-06-05-medicaid-spending-reductions-would-lead-losses-jobs-economic-activity-and-tax-revenue-states <div class="container"><div class="row"><div class="col-md-8"><p>Medicaid is the nation’s largest single source of coverage, providing access to care for 72 million Americans. It primarily serves low-income populations — children and their families, adults, seniors and disabled individuals. Almost half of adults in poverty, nearly 4 in 10 children, and over 60% of nursing home residents are covered by Medicaid. And, for over 12 million dually eligible Medicare-Medicaid enrollees, Medicaid helps with premiums and cost sharing, as well as provides long-term care services. The program provides a broad array of health care services, such as primary and acute care services, as well as long-term services and supports.</p><p>Congress is considering a set of proposed Medicaid cuts that threaten coverage for the millions of Americans who rely on the program and threaten access to health care for all communities. However, there is still significant uncertainty regarding the type, scale and timing of these cuts. As such, the AHA has modeled the statewide economic impacts of each $1 billion incremental reduction in Medicaid spending. These incremental impacts can then be scaled to various spending reduction scenarios to estimate how those cuts may be experienced at the state-level.</p><p>The AHA’s analysis reflects the incremental economic impacts of Medicaid cuts across the entire program in each state, including spending on hospitals, physician offices, specialists and pharmacies. The share of the $1 billion reduction experienced by each sector is based on AHA estimates of that sector’s share of Medicaid spending using data from the Medicaid and CHIP Payment and Access Commission (MACPAC). The AHA then uses economic impact modeling from Lightcast, a labor market analytics company, to estimate how those spending cuts would affect jobs and economic activity by state.</p><p>For every $1 billion reduction in Medicaid spending over 10 years, we estimate:</p><ul><li>The annual average of hospital jobs lost.</li><li>The annual average of total jobs lost across the entire state economy.</li><li>The total 10-year estimated reduction in statewide economic activity.</li><li>The total 10-year estimated loss of federal, state and local tax revenue as a result of the reduction in statewide economic activity.</li></ul><p>These estimates show the broad economic and community impact of Medicaid, beyond just health care coverage and benefits. Medicaid cuts would destabilize communities, harming the economic security and health of the millions of people who keep our economy running strong.</p><h2>Economic Impacts of Each $1B Reduction in Medicaid Spending<a href="#note1">*</a></h2><table><thead><tr><th>State</th><th>Annual Average Hospital Jobs Lost</th><th>Annual Average Total Jobs Lost</th><th>10-Year Reduction in Statewide Economic Activity</th><th>10-Year Loss of Federal, State and Local Tax Revenue</th></tr></thead><tbody><tr><td>Alabama</td><td>1,790</td><td>16,101</td><td>$1.7B</td><td>$41.8M</td></tr><tr><td>Alaska</td><td>1,271</td><td>12,600</td><td>$1.6B</td><td>$41.5M</td></tr><tr><td>Arizona</td><td>1,447</td><td>15,832</td><td>$2.1B</td><td>$61.4M</td></tr><tr><td>Arkansas</td><td>1,756</td><td>15,315</td><td>$1.6B</td><td>$43.8M</td></tr><tr><td>California</td><td>1,122</td><td>14,956</td><td>$2.3B</td><td>$83.1M</td></tr><tr><td>Colorado</td><td>1,396</td><td>14,887</td><td>$2.1B</td><td>$53.7M</td></tr><tr><td>Connecticut</td><td>1,363</td><td>12,353</td><td>$1.8B</td><td>$54.7M</td></tr><tr><td>Delaware</td><td>1,129</td><td>12,178</td><td>$1.6B</td><td>$39.4M</td></tr><tr><td>District of Columbia</td><td>1,143</td><td>8,672</td><td>$1.3B</td><td>$33.8M</td></tr><tr><td>Florida</td><td>1,621</td><td>17,512</td><td>$2.3B</td><td>$74.7M</td></tr><tr><td>Georgia</td><td>1,551</td><td>16,657</td><td>$2.0B</td><td>$52.3M</td></tr><tr><td>Hawaii</td><td>1,316</td><td>14,354</td><td>$1.8B</td><td>$70.1M</td></tr><tr><td>Idaho</td><td>1,404</td><td>15,467</td><td>$1.7B</td><td>$40.9M</td></tr><tr><td>Illinois</td><td>1,455</td><td>15,307</td><td>$2.0B</td><td>$71.6M</td></tr><tr><td>Indiana</td><td>1,573</td><td>14,191</td><td>$1.7B</td><td>$40.8M</td></tr><tr><td>Iowa</td><td>1,584</td><td>14,321</td><td>$1.6B</td><td>$41.0M</td></tr><tr><td>Kansas</td><td>1,640</td><td>15,071</td><td>$1.7B</td><td>$43.5M</td></tr><tr><td>Kentucky</td><td>1,678</td><td>13,964</td><td>$1.6B</td><td>$38.7M</td></tr><tr><td>Louisiana</td><td>1,595</td><td>16,767</td><td>$1.7B</td><td>$50.7M</td></tr><tr><td>Maine</td><td>1,439</td><td>13,403</td><td>$1.7B</td><td>$62.0M</td></tr><tr><td>Maryland</td><td>1,444</td><td>13,074</td><td>$1.7B</td><td>$55.4M</td></tr><tr><td>Massachusetts</td><td>1,302</td><td>12,816</td><td>$1.9B</td><td>$50.5M</td></tr><tr><td>Michigan</td><td>1,571</td><td>15,865</td><td>$1.9B</td><td>$53.6M</td></tr><tr><td>Minnesota</td><td>1,455</td><td>14,733</td><td>$2.0B</td><td>$56.9M</td></tr><tr><td>Mississippi</td><td>1,715</td><td>15,970</td><td>$1.5B</td><td>$44.9M</td></tr><tr><td>Missouri</td><td>1,490</td><td>15,088</td><td>$1.8B</td><td>$43.2M</td></tr><tr><td>Montana</td><td>1,580</td><td>14,837</td><td>$1.7B</td><td>$33.4M</td></tr><tr><td>Nebraska</td><td>1,537</td><td>13,966</td><td>$1.7B</td><td>$46.5M</td></tr><tr><td>Nevada</td><td>1,371</td><td>14,717</td><td>$1.8B</td><td>$52.6M</td></tr><tr><td>New Hampshire</td><td>1,528</td><td>12,344</td><td>$1.7B</td><td>$43.0M</td></tr><tr><td>New Jersey</td><td>1,367</td><td>12,946</td><td>$1.8B</td><td>$68.7M</td></tr><tr><td>New Mexico</td><td>1,380</td><td>14,632</td><td>$1.6B</td><td>$56.9M</td></tr><tr><td>New York</td><td>1,159</td><td>12,131</td><td>$1.9B</td><td>$67.6M</td></tr><tr><td>North Carolina</td><td>1,544</td><td>15,994</td><td>$1.9B</td><td>$50.3M</td></tr><tr><td>North Dakota</td><td>1,555</td><td>13,250</td><td>$1.5B</td><td>$38.3M</td></tr><tr><td>Ohio</td><td>1,564</td><td>15,167</td><td>$1.9B</td><td>$55.7M</td></tr><tr><td>Oklahoma</td><td>1,600</td><td>16,216</td><td>$1.7B</td><td>$37.7M</td></tr><tr><td>Oregon</td><td>1,259</td><td>13,892</td><td>$1.8B</td><td>$49.4M</td></tr><tr><td>Pennsylvania</td><td>1,562</td><td>13,352</td><td>$1.8B</td><td>$53.6M</td></tr><tr><td>Rhode Island</td><td>1,587</td><td>13,101</td><td>$1.7B</td><td>$58.9M</td></tr><tr><td>South Carolina</td><td>1,551</td><td>15,757</td><td>$1.7B</td><td>$52.0M</td></tr><tr><td>uth Dakota</td><td>1,531</td><td>13,167</td><td>$1.6B</td><td>$39.2M</td></tr><tr><td>Tennessee</td><td>1,463</td><td>14,486</td><td>$1.8B</td><td>$51.3M</td></tr><tr><td>Texas</td><td>1,506</td><td>18,178</td><td>$2.2B</td><td>$60.3M</td></tr><tr><td>Utah</td><td>1,487</td><td>15,838</td><td>$1.9B</td><td>$49.3M</td></tr><tr><td>Vermont</td><td>1,498</td><td>13,125</td><td>$1.6B</td><td>$56.1M</td></tr><tr><td>Virginia</td><td>1,410</td><td>13,732</td><td>$1.7B</td><td>$52.5M</td></tr><tr><td>Washington</td><td>1,153</td><td>12,659</td><td>$1.9B</td><td>$77.1M</td></tr><tr><td>West Virginia</td><td>1,525</td><td>13,602</td><td>$1.4B</td><td>$31.4M</td></tr><tr><td>Wisconsin</td><td>1,615</td><td>15,026</td><td>$1.8B</td><td>$50.1M</td></tr><tr><td>Wyoming</td><td>1,462</td><td>13,772</td><td>$1.4B</td><td>$33.5M</td></tr></tbody></table><p><span><strong>Sources:</strong></span> Economic impact modeling conducted by AHA using Lightcast (lightcast.io), as of May 2025, Total Medicaid Benefit Spending by State and Category from MACPAC, and sector employment levels from the North American Industry Classification System (NAICS).</p><p id="note1">* This analysis reflects the incremental economic impacts of each $1B reduction in Medicaid spending across all industries. The share of the $1B reduction experienced by each sector is based on AHA estimates of that sector’s share of Medicaid spending using data from MACPAC. These incremental impacts can be applied to Medicaid spending reductions across the 2026-2035 period. Total jobs lost are a result of the reduction in statewide economic activity; for example, this would include jobs lost because of less hospital spending and higher hospital unemployment resulting in lower economic activity such as buying goods and services. The loss of tax revenue includes reductions in state and local general sales and property taxes.</p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Medicaid-Spending-Reductions-Would-Lead-to-Losses-in-Jobs-Economic-Activity-and-Tax-Revenue-for-States.pdf" target="_blank" title="Click here to download the Medicaid Spending Reductions Would Lead to Losses in Jobs, Economic Activity and Tax Revenue for States PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/06/Medicaid-Spending-Reductions-Would-Lead-to-Losses-in-Jobs-Economic-Activity-and-Tax-Revenue-for-States.pdf" target="_blank" title="Click here to download the Medicaid Spending Reductions Would Lead to Losses in Jobs, Economic Activity and Tax Revenue for States PDF."><img src="/sites/default/files/inline-images/Page-1-Medicaid-Spending-Reductions-Would-Lead-to-Losses-in-Jobs-Economic-Activity-and-Tax-Revenue-for-States.png" data-entity-uuid="4a19bc11-55f8-4e12-ae1d-f41a5f4bef79" data-entity-type="file" alt="Medicaid Spending Reductions Would Lead to Losses in Jobs, Economic Activity and Tax Revenue for States page 1." width="695" height="900"></a></p></div></div></div> table, th, td { border: 1px solid #002855; } table { margin-top: 20px; margin-bottom: 20px; } th { background-color: #002855; color: #ffffff; Thu, 05 Jun 2025 06:00:00 -0500 Fact Sheets /fact-sheets/2025-06-05-medicaid-coverage-supports-rural-patients-hospitals-and-communities <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/16-1-Million-People-in-Rural-Communities-Rely-on-Medicaid.png" data-entity-uuid="5bd93908-0c93-4c85-8af2-4b1d10bc33fb" data-entity-type="file" alt="16.1 Million People in Rural Communities Rely on Medicaid" width="299" height="267" class="align-right">One in seven Americans live in rural areas and rely on rural hospitals and health systems for the health and well-being of their communities.<a href="#fn1"><sup>1</sup></a> The importance of rural hospitals cannot be overstated, as individuals who live in these communities face greater challenges in accessing health care due to a number of factors, including a lack of affordable coverage options, geographic isolation and a shortage of health care providers.<a href="#fn2"><sup>2</sup></a> Medicaid, which covers 16.1 million people in rural communities, plays a vital role in addressing these barriers and sustaining rural hospitals so they can continue to support patients and their communities.<a href="#fn3"><sup>3</sup></a> As part of a larger budget process, many in Congress are currently considering cuts to the Medicaid program, which could have a devastating impact on rural hospitals and patients.</p><h2>Impact of Proposed Medicaid Cuts on Rural Communities</h2><p>Medicaid generally pays hospitals far less than the costs of caring for Medicaid patients. The difference between Medicaid payments and costs incurred by hospitals to provide care, known as the “Medicaid shortfall,” was $27.5 billion in 2023.<a href="#fn4"><sup>4</sup></a> Congress is considering policy options that could collectively reduce federal spending for the Medicaid program by hundreds of billions of dollars over the next 10 years, which would undermine the ability of hospitals, in particular rural hospitals, to continue to serve their patients.</p><p><img src="/sites/default/files/inline-images/Proposed-Cuts-Could-Mean.png" data-entity-uuid="9fe59eda-0e35-4ed2-ac8a-2ce61c8ab427" data-entity-type="file" alt="Proposed Cuts Could Mean: Coverage Losses; Fewer Health Care Services; Fewer Jobs; More Hospital Financial Instability." width="284" height="140" class="align-right">Among the targets for cuts being considered by Congress are supplemental payments, which are used to mitigate historically low Medicaid payment rates for services. These funding sources are critical, as many states have been able to target support to rural hospitals through supplemental payments and lessen the gap between Medicaid base payments and the cost of providing care. If the proposed cuts are enacted, the effects will ripple across rural communities and could result in coverage losses, fewer available health care services, fewer jobs and greater hospital financial instability.</p><h2>The Importance of Rural Hospitals</h2><p><img src="/sites/default/files/inline-images/About-half-of-rural-hospitals-consistently-experienced-negative-operating-margins.png" data-entity-uuid="12f19b20-8b38-4a5f-929a-f6117d5e4ea8" data-entity-type="file" alt="About half of rural hospitals consistently experienced negative operating margins from patient services from 2017-2022." width="238" height="205" class="align-right">Rural hospitals serve as critical – and sometimes the sole – source of care for rural communities. Consequently, rural hospitals face elevated levels of uncompensated care that can be linked to higher uninsured rates in rural communities.<a href="#fn5"><sup>5</sup></a> Due to this and other fiscal pressures, many rural hospitals operate under tight margins and face a disproportionate threat of closure.<a href="#fn6"><sup>6</sup></a> About half of rural hospitals consistently experienced negative operating margins from patient services from 2017-2022.<a href="#fn7"><sup>7</sup></a> Some hospitals have dealt with negative margins by reducing costs, which can include eliminating service lines or closing altogether. According to the UNC Cecil G. Sheps Center, over 100 rural hospitals have closed or converted in the last decade.<a href="#fn8"><sup>8</sup></a></p><p>Hospital closures and service line reductions can be devastating to rural communities. Behavioral health and obstetrics care are two examples where despite a significant need for this care in rural areas, providers and services continue to be limited or entirely unavailable in rural communities due to fiscal and other issues.<a href="#fn9"><sup>9</sup></a><sup>,</sup><a href="#fn10>10</a>,<a href="><sup>11</sup></a> When providers or essential services are not available locally, patients are required to travel long distances or, worse, forego care altogether, leading to health complications and unnecessary hospitalizations.</p><h2>Medicaid’s Role as a Lifeline for Rural Patients, Communities and Hospitals</h2><p>There are three primary ways in which Medicaid supports rural communities and hospitals:</p><h3><img src="/sites/default/files/inline-images/Percentage-of-Rural-Births-Covered-by-Medicaid-2023.png" data-entity-uuid="8fc3d416-2e58-44dd-9f69-7787485f3bc8" data-entity-type="file" alt="Percentage of Rural Births Covered by Medicaid, 2023, by state. Source: Natality data on the CDC WONDER Online Database. Created with Datawrapper." width="404" height="321" class="align-right">1. Medicaid is a critical coverage option for people who live in rural areas.</h3><p>Medicaid is a significant source of coverage for individuals and families in rural areas who would otherwise not be able to afford insurance. In nearly all states, Medicaid covers a larger share of both adults and children in rural communities than urban communities.<a href="#fn12"><sup>12</sup></a> Nearly 50% of children and 18% of adults in rural communities are covered by Medicaid.<a href="#fn13"><sup>13</sup></a> And nearly 50% of babies born in rural areas are covered by Medicaid.<a href="#fn14"><sup>14</sup></a></p><h3>2. Medicaid improves access to care in rural areas.</h3><p>Medicaid is a powerful tool in enabling people to overcome barriers to care. Children with Medicaid coverage are four times more likely to have regular sources of care and two to three times more likely to receive preventive care services than uninsured children.<a href="#fn15"><sup>15</sup></a> Adult Medicaid enrollees are five times more likely to have regular sources of care and four times more likely to receive preventive care services than individuals without coverage. With more patients covered, providers are more likely to be able to sustain themselves financially and, in some cases, expand the services they can offer in rural areas.</p><h3>3. Medicaid stabilizes and strengthens rural hospitals and workers.</h3><p>Medicaid plays a significant role in reducing uncompensated care and stabilizing hospitals in rural communities. Higher rates of Medicaid coverage for adults have been associated with improved hospital financial performance and lower likelihood of closure, especially in rural areas that have expanded Medicaid. The majority (74%) of rural hospital closures happened in states where Medicaid expansion was not in place or had been in place for less than a year.<a href="#fn16"><sup>16</sup></a></p><p>Medicaid coverage directly affects the demand for services in rural areas, and therefore the need for a robust health care workforce. Several studies on the impacts of Medicaid on the primary care and behavioral health workforce showed that states that have expanded Medicaid may be able to recruit, or may attract, additional providers due to the higher demand for services.<a href="#fn17"><sup>17</sup></a></p><p>And Medicaid’s contribution to the workforce is not limited to health care providers — rural hospitals typically serve as one of the largest employers in their communities and economic foundations of their local economy. This allows Medicaid to support more economically stable and vibrant communities.</p><hr><h2>End Notes</h2><ol><li id="fn1"><a href="https://aspe.hhs.gov/sites/default/files/documents/6056484066506a8d4ba3dcd8d9322490/rural-health-rr-30-Oct-24.pdf">aspe.hhs.gov/sites/default/files/documents/6056484066506a8d4ba3dcd8d9322490/rural-health-rr-30-Oct-24.pdf</a></li><li id="fn2"><a href="https://www.gao.gov/blog/why-health-care-harder-access-rural-america" target="_blank">gao.gov/blog/why-health-care-harder-access-rural-america</a></li><li id="fn3"><a href="https://www.kff.org/other/state-indicator/medicaid-enrollees-by-urban-rural-status/?dataView=1&currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D" target="_blank">kff.org/other/state-indicator/medicaid-enrollees-by-urban-rural-status/?dataView=1¤tTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D</a></li><li id="fn4"><a href="/system/files/media/file/2025/02/Fact-Sheet-Medicaid-20250204.pdf" target="_blank">aha.org/system/files/media/file/2025/02/Fact-Sheet-Medicaid-20250204.pdf</a></li><li id="fn5"><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10924546/#:~:text=Rural%20hospitals%20have%20more%20uncompensated,change%20in%20non%2Dexpansion%20states" target="_blank">mc.ncbi.nlm.nih.gov/articles/PMC10924546/#:~:text=Rural%20hospitals%20have%20more%20uncompensated,change%20in%20non%2Dexpansion%20states</a></li><li id="fn6"><a href="https://www.kff.org/health-costs/issue-brief/hospital-margins-rebounded-in-2023-but-rural-hospitals-and-those-with-high-medicaid-shares-were-struggling-more-than-others/#:~:text=About%20half%20of%20low%2Dvolume,designation%20had%20negative%20operating%20margins" target="_blank">kff.org/health-costs/issue-brief/hospital-margins-rebounded-in-2023-but-rural-hospitals-and-those-with-high-medicaid-shares-werestruggling-more-than-others/#:~:text=About%20half%20of%20low%2Dvolume,designation%20had%20negative%20operating%20margins</a></li><li id="fn7"><a href="/system/files/media/file/2024/04/Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.pdf" target="_blank">aha.org/system/files/media/file/2024/04/Assessing-the-Impact-of-COVID-19-on-Rural-Hospitals-report.pdf</a></li><li id="fn8"><a href="https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/" target="_blank">shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/</a>; converted facilities no longer offer inpatient services but continue to provide some health care services.</li><li id="fn9"><a href="https://familymedicine.uw.edu/rhrc/publications/changes-in-the-supply-and-rural-urban-distribution-of-selected-behavioral-health-providers/" target="_blank">familymedicine.uw.edu/rhrc/publications/changes-in-the-supply-and-rural-urban-distribution-of-selected-behavioral-health-providers/</a></li><li id="fn10"><a href="https://www.gao.gov/products/gao-23-105515" target="_blank">gao.gov/products/gao-23-105515</a></li><li id="fn11"><a href="https://www.gao.gov/blog/additional-risks-and-challenges-pregnant-women-rural-and-underserved-communities" target="_blank">gao.gov/blog/additional-risks-and-challenges-pregnant-women-rural-and-underserved-communities</a></li><li id="fn12"><a href="https://www.kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/" target="_blank">kff.org/medicaid/issue-brief/the-role-of-medicaid-in-rural-america/</a></li><li id="fn13"><a href="https://ccf.georgetown.edu/2023/08/17/medicaids-coverage-role-in-small-towns-and-rural-areas/" target="_blank">ccf.georgetown.edu/2023/08/17/medicaids-coverage-role-in-small-towns-and-rural-areas/</a></li><li id="fn14"><a href="/system/files/media/file/2025/02/Fact-Sheet-Medicaid-20250204.pdf" target="_blank">aha.org/system/files/media/file/2025/02/Fact-Sheet-Medicaid-20250204.pdf</a></li><li id="fn15"><a href="https://www.ahip.org/resources/the-value-of-medicaid-providing-access-to-care-and-preventive-health-services" target="_blank">ahip.org/resources/the-value-of-medicaid-providing-access-to-care-and-preventive-health-services</a></li><li id="fn16"><a href="/system/files/media/file/2022/09/rural-hospital-closures-threaten-access-report.pdf" target="_blank">aha.org/system/files/media/file/2022/09/rural-hospital-closures-threaten-access-report.pdf</a></li><li id="fn17"><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9262825/" target="_blank">EFFECTS OF THE ACA MEDICAID EXPANSION ON THE COMPENSATION OF NEW PRIMARY CARE PHYSICIANS - PMC</a></li></ol></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/06/Medicaid-Coverage-Supports-Rural-Patients-Hospitals-and-Communities.pdf" target="_blank" title="Click here to download the Medicaid Coverage Supports Rural Patients, Hospitals, and Communities fact sheet PDF.">Download the Fact Sheet PDF</a></div><a href="/system/files/media/file/2025/06/Medicaid-Coverage-Supports-Rural-Patients-Hospitals-and-Communities.pdf" target="_blank" title="Click here to download the Medicaid Coverage Supports Rural Patients, Hospitals, and Communities fact sheet PDF."><img src="/sites/default/files/inline-images/Page-1-Medicaid-Coverage-Supports-Rural-Patients-Hospitals-and-Communities-20250605.png" data-entity-uuid="60c6085a-1780-4fb4-8f27-76caf6eddc36" data-entity-type="file" alt="Medicaid Coverage Supports Rural Patients, Hospitals, and Communities fact sheet page 1." width="693" height="900"></a><p> <div class="views-element-container"> <section class="top-level-view js-view-dom-id-be8042fe4b990c10801c72a1fc5ab77f0b4963cc9f33a813ba78e2498232f160 resource-block"> <h3>Related Podcasts</h3> <div class="resource-wrapper"> <div class="resource-view"> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2025-07-16-behind-bill-what-one-big-beautiful-bill-act-means-hospitals-and-health-systems" hreflang="en">Behind the Bill: What the One Big Beautiful Bill Act Means for Hospitals and Health Systems</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2025-07-02-when-medicaid-disappears-how-cuts-could-devastate-behavioral-health-care-rural-america" hreflang="en">When Medicaid Disappears: How Cuts Could Devastate Behavioral Health Care in Rural America</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2024-05-31-impact-new-prior-authorization-rule" hreflang="en">The Impact of the New Prior Authorization Rule</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2023-04-24-how-one-hospital-navigating-rising-inflation-and-workforce-pressures" hreflang="en">How One Hospital Is Navigating Rising Inflation and Workforce Pressures</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2022-10-02-partnering-area-agencies-aging-tactics-success" hreflang="en">Partnering with Area Agencies on Aging: Tactics for Success</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> <div class="article views-row"> <div class="views-field views-field-title"> <span class="field-content"><a href="/advancing-health-podcast/2021-04-08-leadership-rounds-alvin-hoover" hreflang="en">Leadership Rounds with Alvin Hoover</a></span> </div><div class="views-field views-field-field-type"> <div class="field-content"><a href="/type/advancing-health-podcast" hreflang="en">Advancing Health Podcast</a></div> </div></div> </div> </div> </section> </div> </p></div></div></div> h2 { color: #9d2235; } h3 { color: #003087; } Thu, 05 Jun 2025 06:00:00 -0500 Fact Sheets