/ en Sun, 15 Jun 2025 00:50:06 -0500 Thu, 05 Jun 25 13:09:04 -0500 /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></div></div></div> h2 { color: #9d2235; } h3 { color: #003087; } Thu, 05 Jun 2025 06:00:00 -0500 Fact Sheets /fact-sheets/2023-04-19-fact-sheet-workplace-violence-and-intimidation-and-need-federal-legislative-response <div class="container"><div class="row"><div class="col-md-8"><h2>The Issue</h2><p>For the past decade, the health care field has experienced a sharp increase in workplace violence. Several factors have imposed significant stress on the entire health care system, and in some instances, patients, visitors and family members have attacked health care staff and jeopardized our workforce’s ability to provide care. This rise in workplace violence has shown no indication of subsiding. Hospitals, health systems and providers support the enactment of a federal law that would protect health care workers from violence, just as current federal law protects airline and airport workers.</p><h2>Background</h2><p>Hospitals and health systems have long had robust protocols to detect, deter and respond to violence against their team members. However, violence against hospital employees continues to increase. </p><p>Day after day, the media reports on patients or family members assaulting hospital staff, sometimes with deadly consequences. For example, a Kentucky nurse was choked, thrown to the ground, and hit by a patient who later told police she was mad because “staff was taking too long to discharge her from the hospital.”<sup>1</sup> Last year, a Florida physician sustained a concussion, brain contusion and two broken ribs after an alleged attack by a patient’s relative.<sup>2</sup> </p><p>Data supports these news accounts. A Press Ganey survey found that on average, two nurses are assaulted every hour in the U.S., and a 2024 American College of Emergency Physicians survey found that 9 out of 10 respondents reported having been attacked or threatened in the past year. </p><p>Workplace violence has severe consequences for the entire health care system. Not only do these assaults cause physical and psychological injury for health care workers, but they make it more difficult for nurses, physicians and other clinical staff to provide quality patient care. Nurses and physicians cannot provide attentive care when they are afraid for their safety, distracted by disruptive patients and family members, or traumatized from prior violent interactions. </p><p>In addition, violent interactions at health care facilities tie up valuable resources and can delay urgently needed care for other patients. Studies show that workplace violence reduces patient satisfaction and employee productivity and increases the potential for adverse medical events.</p><h2>AHA Take</h2><p>Despite the incidence of workplace violence and its harmful effects on our health care system, no federal law protects hospital workers from workplace assault. By contrast, Congress responded to increases in violent behavior on commercial aircraft and in airports by enacting a federal law criminalizing attacks against those employees. Vigorous enforcement of these federal laws helps to create a safer traveling environment, deters violent behavior and ensures that offenders are appropriately punished. Our nation’s health care workers, who tirelessly treat patients while facing increased violence, deserve the same legal protections as airline workers. <span><strong>Congress should enact the bipartisan Save Healthcare Workers Act (H.R. 3178/S. 1600), which provides protections similar to those in current law for flight crews, flight attendants and airport workers. </strong></span></p><p>The Save Healthcare Workers Act would make it a federal crime to knowingly assault a hospital worker on the job and establish fines, imprisonment, or both for these offenses. The legislation creates an affirmative defense if the assault results from the perpetrator’s physical, mental or intellectual disability; in other words, if a patient, family member or visitor assaults a health care worker because of such a disability, that person could not be prosecuted.<br>__________<br><small class="sm"><sup>1</sup> Mike Stunson, Patient chokes nurse because her discharge was taking too long, Kentucky cops say, Lexington Herald Leader (April 28, 2025)</small><br><small class="sm"><sup>2</sup> Mariah Taylor, Florida physician injured after alleged attack by patient’s son, Becker’s Hospital Review (Oct.16, 2024)</small><br><a class="ck-anchor" id="https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/" href="https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/"><small class="sm">https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-injured-after-alleged-attack-by-patients-son/</small></a><small class="sm"> </small></p><p> </p></div><div class="col-md-4"><p><a href="/system/files/media/file/2022/09/Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response.pdf" target="_blank" title="Click here to download the Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response PDF."><img src="/sites/default/files/2025-05/cover-Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response-r-5-28-2025.png" data-entity-uuid data-entity-type="file" alt="Cover: Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response May 28, 2025" width="NaN" height="NaN"></a></p><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2022/09/Fact-Sheet-Workplace-Violence-and-Intimidation-and-the-Need-for-a-Federal-Legislative-Response.pdf" target="_blank" title="Click here to download the Fact Sheet: Workplace Violence and Intimidation, and the Need for a Federal Legislative Response PDF.">Download the PDF</a></div></div></div></div> Wed, 28 May 2025 14:49:00 -0500 Fact Sheets /2025-05-08-fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-care-patients-and <div class="container"><div class="row"><div class="col-md-8"><h2><span><em>The Issue</em></span></h2><p>Congress is considering several proposals that would impose additional Medicare site-neutral payment reductions for services provided in hospital outpatient departments (HOPDs). A description of these proposals and the potential impact they would have on Medicare reimbursement to hospitals and health systems follow. <span><strong>The AHA is opposed to any additional site-neutral cuts, which would endanger the critical role hospitals and health systems play in their communities, including access to care for patients.</strong></span></p><h2><span><em>The Proposals Under Consideration</em></span></h2><hr><ul><li><u>Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)</u>: In its June 2023 Report to the Congress, MedPAC recommended that payments should be aligned across HOPDs, both on-campus and off-campus, ambulatory surgical centers and physician offices for certain ambulatory payment classification (APC) groups. The site-neutral payment rate that would apply to the services in each APC would be based on the Medicare payment system for the ambulatory setting in which these services are most commonly furnished. <span><strong>According to an AHA analysis, this proposal would result in a cut to hospitals of $167.1 billion over 10 years.</strong></span></li><li>The Lowering Health Costs for Seniors Framework, released by Senators Bill Cassidy, M.D. (R-LA) and Maggie Hassan (D-NH) outlines two potential options for site-neutral cuts: <ul><li>Policy Option 1: Eliminating the grandfathering exception to apply site-neutral cuts to all offcampus HOPDs</li><li>Policy Option 2: Imposing the MedPAC proposal outlined above to apply site-neutral cuts to on campus and off-campus HOPDs. As part of this option, the framework also proposes to reinvest a portion of the cuts back to certain types of rural and safety-net hospitals. <span><strong>According to an AHA analysis, accounting for the reinvestments, Policy Option 2 would result in a cut to hospitals of $114.4 billion over 10 years.</strong></span></li></ul></li><li>The <u>SITE Act</u> would expand site-neutral payment cuts for all services furnished in grandfathered off-campus HOPDs, other than evaluation and management services, which are already paid at a site-neutral rate. This would include off-campus HOPDs and some items and services that Congress had previously exempted from site-neutral payment under Medicare, including dedicated emergency departments and CMS-approved “mid-build” off-campus provider-based departments. <span><strong>According to an AHA analysis, this would result in a cut to hospitals of $32 billion over 10 years.</strong></span></li><li><u>The Lower Costs, More Transparency Act</u> contains a provision that would cut reimbursements for drug administration services at off-campus HOPDs. Phased in over four years, drug administration services furnished in grandfathered off-campus HOPDs would be paid at a site-neutral rate, delaying implementation for certain rural and cancer hospitals by one year. <span><strong>According to an AHA analysis, this Act would result in a cut to hospitals of $4 billion over 10 years.</strong></span></li></ul><p><span><em>Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)</em></span></p><hr><img src="/sites/default/files/inline-images/image_49.png" data-entity-uuid="c23816f6-0ad4-49fa-88d2-640c490ec8c1" data-entity-type="file" width="683" height="909" alt="Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)"><p><span><em>Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation) - (Continued)</em></span></p><img src="/sites/default/files/inline-images/image_54.png" data-entity-uuid="c93f97c7-726f-4467-bd9a-f5310f5e1e7e" data-entity-type="file" alt="Estimated Impact Analysis of the Hospital On-Campus and Off-Campus Site-Neutral Proposal (MedPAC Recommendation)" width="683" height="465"><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2022 and June 2023. </p><p><span><strong>Notes: </strong></span></p><ol><li>In AHA’s modeling of this “All HOPDs MedPAC Site-neutral” recommendation, rather than recreating the process outlined by MedPAC in its reports to identify the impacted APCs, we used a list of APCs previously identified by MedPAC and modeled the site-neutral payment rate for services in those APCs at 40 percent of the OPPS rate, i.e., a reduction of 60 percent.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><span><em>Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework</em></span></p><img src="/sites/default/files/inline-images/image_58.png" data-entity-uuid="9aac639a-3a84-4167-a0a3-7ebaa5edc675" data-entity-type="file" alt="Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework" width="683" height="906"><p><em>Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework (Continued)</em></p><figure><img src="/sites/default/files/inline-images/image_65.png" data-entity-uuid="c365f697-1aa9-4a43-a48f-d25ef6f6bb7f" data-entity-type="file" alt="Estimated Impact Analysis of Policy Option 2 in the Lowering Health Costs For Seniors Framework (Continued)" width="683" height="469"></figure><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; AHA Annual Survey Database, 2022; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2022 and June 2023</p><p><span><strong>Notes:</strong> </span></p><ol><li>In AHA’s modeling of this “All HOPDs MedPAC Site-neutral” recommendation, rather than recreating the process outlined by MedPAC in its reports to identify the impacted APCs, we used a list of APCs previously identified by MedPAC and modeled the site-neutral payment rate for services in those APCs at 40 percent of the OPPS rate, i.e., a reduction of 60 percent. </li><li>As outlined in the Lowering Health Costs For Seniors Framework, Policy Option 2 proposes possible reinvestment mechanisms for rural and safety net hospitals based on their outpatient revenue and core lines of services offered by the hospital, as well as through value-based reimbursement. We modeled the option related to outpatient revenue and core lines of service.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><em>Estimated Impact Analysis of the SITE Act</em></p><p><img src="/sites/default/files/inline-images/image_60.png" data-entity-uuid="a85d7b6d-8f75-4202-8442-8cc76421f8ef" data-entity-type="file" alt="Estimated Impact Analysis of the SITE Act" width="683" height="956"><img src="/sites/default/files/inline-images/image_61.png" data-entity-uuid="3e82f6e2-7f17-442f-8b97-a132e41c0674" data-entity-type="file" alt="Estimated Impact Analysis of the SITE Act" width="678" height="342"></p><p><span><strong>Sources:</strong></span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2019-2024; Medicare Payment Advisory Commission (MedPAC), “Report to the Congress: Medicare and the Health Care Delivery System,” June 2018. </p><p><span><strong>Notes:</strong> </span></p><ol><li>In AHA’s modeling of the SITE Act, we did not model the impact of imposing site-neutral payment cuts to CMS-confirmed “mid-build” off-campus provider-based departments (PBDs) that Congress previously exempted from site-neutral payment under Medicare. Also, it is our understanding that the Act is not intended to apply to off-campus PBDs belonging to the 11 dedicated cancer hospitals, hence the impacts do not include any cuts to those PBDs.</li><li>The SITE Act would cut payment by 30 percent for items and services in off-campus dedicated emergency departments (EDs) that are located 6 or less miles from any other hospital, critical-access hospital (CAH) or rural emergency hospital (REH), including the parent hospital’s ED. Since the Medicare claims data do not contain the necessary information to model this provision, we relied on a CBO score published in the June 2018 MedPAC Report to the Congress, with a projected national impact of $50 - $250 million due to a MedPAC-proposed 30 percent reduction in payments for services provided by urban off-campus EDs that are within 6 miles of an on-campus hospital ED. We conservatively took the midpoint of this range and inflated it to 2026 using CBO’s actual and projected payments contained in their Medicare baselines. Using data contained in outpatient fee-for-service claims billed by hospitals with the “ER” modifier (outpatient items and services furnished by a provider‐based off‐campus ED), we applied the estimated state shares to the estimated national total. Since the CBO score applies only to urban off-campus EDs within 6 miles of an on-campus hospital ED, but the SITE Act applies to all off-campus EDs within 6 miles of any other hospital, CAH, or REH, including the parent hospital of such ED, the CBO score is most probably an underestimate of the actual impact that would occur.</li><li>With the exception of the off-campus ED impact methodology mentioned in note 2, for all other off-campus grandfathered non-E&M services, we estimated the site‐neutral payment rate to be 40 percent of the OPPS payment rate i.e., a reduction of 60 percent.</li><li>Puerto Rico did not report any lines for off-campus grandfathered non-E&M services in the claims data and is not shown in the table. States with very low impacts are shown in the table but have very few reported off-campus grandfathered non- E&M services.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</li></ol><p><em>Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act</em></p><p><img src="/sites/default/files/inline-images/image_62.png" data-entity-uuid="6a70d03d-6911-42c0-bee3-ea8a1faa896a" data-entity-type="file" alt="Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act" width="683" height="931"></p><p>Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act (Continued)</p><p><img src="/sites/default/files/inline-images/image_64.png" data-entity-uuid="4cb2a443-a514-45df-9ae0-ede70db33577" data-entity-type="file" alt="Estimated Impact Analysis of Site-neutral Cut in the Lower Costs, More Transparency Act" width="683" height="389"></p><p><span>Sources:</span> Centers for Medicare & Medicaid Services (CMS), calendar year (CY) 2023 outpatient prospective payment system (OPPS) final rule rate-setting and outpatient limited data set standard analytical files; CY 2025 OPPS final rule and associated public use files; CMS Provider of Services Files, 2023 and 2024; Congressional Budget Office (CBO), Medicare Baseline Projections, 2024. </p><p><span><strong>Notes: </strong></span></p><ol><li>The Lower Costs, More Transparency Act defines off-campus grandfathered drug administration services as those that are assigned to designated ambulatory payment classification (APC) groups. While it does not explicitly list the APCs, an AHA coding expert identified four drug administration APCs: 5691-5694. Hence, we used these APCs in our modeling.</li><li>We estimated the site‐neutral payment rate to be 40 percent of the OPPS payment rate i.e., a reduction of 60 percent.</li><li>Since the Lower Costs, More Transparency Act calls for a 4-year transition period, we assumed that cuts would result in 25 percent of the full impact in 2026, 50 percent in 2027, 75 percent in 2028 and 100 percent (full implementation) in 2029 and beyond. It is possible that CMS could adopt a different schedule for the transition period. The impacts shown do not include a one-year delay in implementation for certain rural and cancer hospitals.</li><li>Wyoming and Puerto Rico did not report any lines for off-campus grandfathered drug administration services in the claims data and are not shown in the table. States with very low impacts are shown in the table but have very few reported off-campus grandfathered drug administration services.</li><li>We modeled OPPS payments using CY 2023 data files and CY 2025 final rule policies. Payments were inflated to 2026 and projected through 2035 using CBO’s actual and projected payments for hospital outpatient services contained in their June 2024 Medicare baseline.</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/2025/05/fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.pdf" target="_blank" title="Click here to download the Fact Sheet: Medicare Site-neutral Legislative Proposals Under Consideration Would Jeopardize Access to Care for Patients and Communities PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/05/fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.pdf"><img src="/sites/default/files/2025-05/cover-fact-sheet-medicare-site-neutral-legislative-proposals-under-consideration-would-jeopardize-access-to-care-for-patients-and-communities.png" data-entity-uuid data-entity-type="file" alt="Cover Fact Sheet: Medicare Site-neutral Legislative Proposals Under Consideration Would Jeopardize Access to Care for Patients and Communities" width="695" height="899" class="align-center"></a></p></div></div></div> Thu, 08 May 2025 16:08:29 -0500 Fact Sheets /fact-sheets/2025-05-08-fact-sheet-estimated-impact-hospital-campus-and-campus-site-neutral-proposal <div class="container"><div class="row"><div class="col-md-8"><p>Legislative efforts to enact a Medicare Payment Advisory Commission (MedPAC) proposal that would impose site-neutral payment cuts on hospitals for certain outpatient services — including those occurring in both on-campus and off-campus hospital outpatient departments (HOPDs) — would lead to significant and unacceptable Medicare cuts for hospitals and health systems, jeopardizing access to hospital care for millions of Americans.</p><p>The AHA remains firmly opposed to proposals that would expand site-neutral payment cuts for hospitals. Current Medicare payment rates, despite paying substantially less than the cost of care, recognize that hospital outpatient departments (HOPDs) are unique. HOPDs treat sicker, more complex patients from medically underserved populations; they also follow more rigorous licensing, accreditation and regulatory requirements compared to other care settings.</p><p>Hospitals and health systems, including their HOPDs, need the financial and operational resources to provide high acuity services that only hospitals can provide. This includes maintaining 24/7 capacity to respond to natural and man-made disasters, public health emergencies, and other unexpected traumatic events. It also means being available to care for all individuals experiencing an emergency<br>regardless of their ability to pay. Further site neutral cuts could result in hospitals closing or reducing these vital services, reducing patient access in communities nationwide, particularly in rural and underserved areas.</p><p>Site-neutral policies also threaten the viability of local economies, which hospitals support through job creation and investments in local goods and services. Every dollar a hospital spends in their community generates an additional <span><strong>$3.49</strong></span> in business activity. Thus, large hospital payment cuts, like those proposed by MedPAC, will result in devastating ripple effects that would disrupt economic activity across communities.</p><p>An AHA analysis found that this framework would result in approximately $167 billion in cuts to hospitals and health systems over 10 years. Using data from Lightcast, the AHA found that this amount of revenue loss would result in:</p><ul><li><span>42,000</span> fewer hospital jobs in the first year alone.</li><li><span>169,000</span> fewer jobs in hospitals’ local communities in the first year alone.</li><li>Nearly <span>$600 billion</span> in reduced 10-year total economic activity.</li></ul><p>These losses are simply unsustainable for hospitals and the communities they serve.</p><p>The AHA urges Congress to reject site-neutral payment cuts to avoid jeopardizing access to essential hospital care and weakening economic growth in communities across the country.<br>__________</p><p><small class="sm"><sup>1</sup></small><a href="/system/files/media/file/2023/03/Comparison-of-Medicare-Beneficiary-Characteristics-Between-2 Hospital-Outpatient-Departments-and-Other-Ambulatory-Care-Settings.pdf" target="_blank" title="Medicare Beneficiary Characteristics PDF"><small class="sm">/system/files/media/file/2023/03/Comparison-of-Medicare-Beneficiary-Characteristics-Between-2 Hospital-Outpatient-Departments-and-Other-Ambulatory-Care-Settings.pdf</small></a></p><p><small class="sm">2 AHA analysis of Lightcast (2023), “Impact Scenario Detailed Effect – General Medical and Surgical Hospitals,” at lightcast.io.</small></p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/05/fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.pdf" target="_blank" title="Click here to download the Fact Sheet: Estimated Impact of Hospital On-campus and Off-campus Site-Neutral Proposal PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/05/fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.pdf"><img src="/sites/default/files/2025-05/cover-fact-sheet-estimated-impact-of-hospital-on-campus-and-off-campus-site-neutral-proposal.png" data-entity-uuid data-entity-type="file" alt="Cover Fact Sheet: Estimated Impact of Hospital On-campus and Off-campus Site-Neutral Proposal" width="695" height="899" class="align-center"></a></p></div></div></div> Thu, 08 May 2025 15:55:13 -0500 Fact Sheets /fact-sheets/2025-05-01-fact-sheet-hospital-impacts-capita-cap-medicaid-expansion-population <div class="container"><div class="row"><div class="col-md-8"><p>Policymakers are considering different approaches to reduce Medicaid spending. One of the approaches could implement per capita caps, in which the federal government would set a fixed spending amount for each beneficiary and adjust that amount annually based on an inflationary rate that would not account for changes in Medicaid costs. Such a cap could be implemented for the entire Medicaid program or could be applied to certain beneficiary populations, such as the Medicaid expansion population. States could be wholly responsible for any costs per beneficiary that exceed this cap.</p><p>A per capita cap on federal Medicaid financing would be a fundamental change to how the program is financed and, specifically, would amount to a substantial cut that would grow over time. Such an approach could put untenable fiscal pressures on state governments, leading to reductions in Medicaid coverage and enrollment, as well as provider reimbursement cuts. The data below demonstrate the potential effects of a Medicaid expansion per capita cap on hospitals, assuming that states would be unable to increase their Medicaid contributions beyond current levels.</p><p>These cuts would be felt well beyond the Medicaid program. The reductions could force hospitals to make difficult decisions about reducing staffing and service lines and whether they will be able to remain open and continue to serve Medicaid beneficiaries as well as the wider community.</p><h2>Hospital Impacts from a Per Capita Cap on the Medicaid Expansion Population</h2><table><thead><tr><th>State</th><th>1-Year Hospital Impacts</th><th>10-Year Hospital Impacts</th></tr></thead><tbody><tr><td>U.S. Total</td><td>-$18.9B</td><td>-$199.9B</td></tr><tr><td>Alaska</td><td>-$46M</td><td>-$486M</td></tr><tr><td>Arizona</td><td>-$797M</td><td>-$8.4B</td></tr><tr><td>Arkansas</td><td>-$181M</td><td>-$1.9B</td></tr><tr><td>California</td><td>-$4.1B</td><td>-$43.1B</td></tr><tr><td>Colorado</td><td>-$196M</td><td>-$2.1B</td></tr><tr><td>Connecticut</td><td>-$233M</td><td>-$2.5B</td></tr><tr><td>Delaware</td><td>-$51M</td><td>-$538M</td></tr><tr><td>District of Columbia</td><td>-$75M</td><td>-$795M</td></tr><tr><td>Hawaii</td><td>-$82M</td><td>-$868M</td></tr><tr><td>Idaho</td><td>-$59M</td><td>-$622M</td></tr><tr><td>Illinois</td><td>-$980M</td><td>-$10.4B</td></tr><tr><td>Indiana</td><td>-$343M</td><td>-$3.6B</td></tr><tr><td>Iowa</td><td>-$222M</td><td>-$2.3B</td></tr><tr><td>Kentucky</td><td>-$720M</td><td>-$7.6B</td></tr><tr><td>Louisiana</td><td>-$888M</td><td>-$9.4B</td></tr><tr><td>Maine</td><td>-$64M</td><td>-$677M</td></tr><tr><td>Maryland</td><td>-$271M</td><td>-$2.9B</td></tr><tr><td>Massachusetts</td><td>-$324M</td><td>-$3.4B</td></tr><tr><td>Michigan</td><td>-$791M</td><td>-$8.4B</td></tr><tr><td>Minnesota</td><td>-$221M</td><td>-$2.3B</td></tr><tr><td>Missouri</td><td>-$273M</td><td>-$2.9B</td></tr><tr><td>Montana</td><td>-$86M</td><td>-$911M</td></tr><tr><td>Nebraska</td><td>-$53M</td><td>-$561M</td></tr><tr><td>Nevada</td><td>-$301M</td><td>-$3.2B</td></tr><tr><td>New Hampshire</td><td>-$27M</td><td>-$285M</td></tr><tr><td>New Jersey</td><td>-$576M</td><td>-$6.1B</td></tr><tr><td>New Mexico</td><td>-$264M</td><td>-$2.8B</td></tr><tr><td>New York</td><td>-$1.3B</td><td>-$14.2B</td></tr><tr><td>North Carolina</td><td>-$1.1B</td><td>-$11.2B</td></tr><tr><td>North Dakota</td><td>-$20M</td><td>-$215M</td></tr><tr><td>Ohio</td><td>-$603M</td><td>-$6.4B</td></tr><tr><td>Oklahoma</td><td>-$362M</td><td>-$3.8B</td></tr><tr><td>Oregon</td><td>-$548M</td><td>-$5.8B</td></tr><tr><td>Pennsylvania</td><td>-$654M</td><td>-$6.9B</td></tr><tr><td>Rhode Island</td><td>-$59M</td><td>-$628M</td></tr><tr><td>South Dakota</td><td>-$18M</td><td>-$188M</td></tr><tr><td>Utah</td><td>-$98M</td><td>-$1B</td></tr><tr><td>Vermont</td><td>-$20M</td><td>-$216M</td></tr><tr><td>Virginia</td><td>-$1.2B</td><td>-$12.3B</td></tr><tr><td>Washington</td><td>-$655M</td><td>-$6.9B</td></tr><tr><td>West Virginia</td><td>-$99M</td><td>-$1B</td></tr></tbody></table><p><span><em><strong>Note:</strong></em></span><em> The impacts above assume that per capita caps are adjusted annually using CPI-U, and include both federal and state spending. State estimates may not add to total due to rounding. The chart does not include impacts on Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming as these states have not expanded their Medicaid program.</em></p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/05/Fact-Sheet-Hospital-Impacts-from-a-Per-Capita-Cap-on-the-Medicaid-Expansion-Population.pdf" target="_blank" title="Click here to download the Fact Sheet: Hospital Impacts from a Per Capita Cap on the Medicaid Expansion Population PDF.">Download the Fact Sheet PDF</a></div><p><a href="/system/files/media/file/2025/05/Fact-Sheet-Hospital-Impacts-from-a-Per-Capita-Cap-on-the-Medicaid-Expansion-Population.pdf"><img src="/sites/default/files/inline-images/Page-1-Fact-Sheet-Hospital-Impacts-from-a-Per-Capita-Cap-on-the-Medicaid-Expansion-Population.png" data-entity-uuid="a783a0cd-805d-4392-a4d4-e5fad7da5588" data-entity-type="file" alt="Fact Sheet: Hospital Impacts from a Per Capita Cap on the Medicaid Expansion Population page 1." width="695" height="900" class="align-center"></a></p></div></div></div> th { color: #ffffff; } table, th, td { border: 1px solid #003087; text-align: center; } h2 { color: #003087; } table { margin-top: 20px; margin-bottom: 20px; width: 100%; } Thu, 01 May 2025 11:20:33 -0500 Fact Sheets /fact-sheets/2025-02-07-fact-sheet-telehealth <div class="container"><div class="row"><div class="col-md-8"><p><img src="/sites/default/files/inline-images/New-normal-vast-majority-of-hospitls-continue-to-use-telehealth.png" data-entity-uuid="4982c706-02b2-4af6-8ee7-9d6bea526a6e" data-entity-type="file" alt="New normal: vast majority of hospitals continue to use telehealth. Percent of hospitals offering telehealth services, 2018 to 2022. 2018: 72.6%. 2019: 78.3%. 2020: 85.1%. 2021: 86.0%. 2022: 86.9%. Note: AHA analysis of survey respondents to the 2018-2022 AHA Annual Survey. Telehealth services may be offered through the health system, a joint venture, or through the hospital itself." width="377" height="408" class="align-right">Telehealth is now a routine way for patients to access health care services and for providers in remote and other areas to access specialty consults that expand their ability to treat patients in their local communities. Telehealth adoption has grown significantly over the past five years due to waivers that enabled more services to be delivered via telehealth under more circumstances and for the providers of those services to be reimbursed. It has been proven safe and effective, and both patients and clinicians report high satisfaction. Prior concerns that telehealth would add utilization — and therefore cost — to the health care system have not been borne out.</p><p>Unfortunately, without congressional action, patients and providers may soon lose access to important telehealth services. <span><strong>We urge Congress to not send the health care system backward and instead make permanent the telehealth flexibilities granted during the pandemic.</strong></span></p><h2>AHA Position</h2><p>As outlined in our <a href="/fact-sheets/2025-02-07-fact-sheet-2025-telehealth-advocacy-agenda">telehealth advocacy agenda</a>, the AHA supports:</p><ul><li><span><strong>Permanently adopting expanded access to telehealth:</strong></span> Permanent adoption of telehealth flexibilities will provide a firm foundation to preserve access and support further reform. We urge Congress to lift geographic and originating site restrictions, allow Rural Health Clinics and Federally Qualified Health Centers to serve as distant sites, expand practitioners who can provide telehealth, remove arbitrary in-person visit requirements for behavioral health, and allow the continuation of audio-only telehealth services.</li><li><span><strong>Expanding the telehealth workforce:</strong></span> Expanding the telehealth workforce will serve as a force multiplier to increase access for areas with health care staffing shortages. Specific policies (like codifying virtual supervision flexibilities), removing barriers to cross-state licensure and eliminating dangerous reporting requirements (like provider home addresses) will increase the telehealth workforce.</li><li><span><strong>Ensuring fair and adequate telehealth reimbursement:</strong></span> Virtual care still has costs, including for both personnel, technology, and office space out of which many telehealth providers work. Appropriate reimbursement is necessary to preserve increased access to care.</li><li><span><strong>Supporting telehealth for rural and medically underserved areas:</strong></span> One barrier to expanding telehealth to these populations has been a lack of access to enabling technologies (like broadband, reliable Wi-Fi or smartphones), as well as education to support digital literacy. As such, we encourage cross-agency collaboration to develop training and infrastructure investment. Additionally, arbitrary requirements, like mandatory in-person visit requirements for behavioral health or prior to prescribing of controlled substances, have limited access for communities that may not have a practitioner available in person. We have urged for the development of a new, streamlined special registration process to waive in-person visit requirements for prescribing controlled substances.</li></ul><h2>Key Facts</h2><ul><li>Recent data from the Kaiser Family Foundation indicates that while utilization of telehealth has declined since 2020, utilization remains higher than pre-pandemic levels. In the last quarter of 2023, over 12.6% of Medicare beneficiaries received a telehealth service.<a href="#fn1"><sup>1</sup></a></li><li>There is a growing body of evidence showing that telehealth does not result in additive or duplicative care. A study of over 35 million records by Epic found that for most telehealth visits across 33 specialties, there was no need for an in-person follow-up visit within 90 days of the telehealth visit.<a href="#fn2"><sup>2</sup></a></li><li>Recent data suggest that the United States will face a physician shortage of up to 86,000 physicians by 2036.<a href="#fn3"><sup>3</sup></a> Telehealth is a critical supporting element to address the growing shortage of physicians.</li><li>Patients across geographies and settings, including both rural and urban areas, have benefited from the increased access and improved convenience provided by telehealth services since patients could receive care from their homes. In fact, data from the Office of the Assistant Secretary for Planning and Evaluation (ASPE) showed that most patients using telehealth in 2020 (92%) received telehealth from their home.<a href="#fn4"><sup>4</sup></a> >/li></li><li>The availability of audio-only telehealth is a critical option to ensure access to care when patients may not have access to technology or bandwidth for video visits. A 2021 report from ASPE found that the majority of surveyed respondents 65 and older used audio-only visits (56.5%) compared to video visits, partly driven by the fact that over 26% of Medicare beneficiaries reported not having computer or smartphone access at home.<a href="#fn5"><sup>5</sup></a></li><li>The lack of broadband infrastructure exacerbates access challenges for certain areas. The Federal Communications Commission reports that over 22% of Americans in rural areas lack access to appropriate broadband (fixed terrestrial 25/3 Mbps) compared to 1.5% in urban areas.<a href="#fn6"><sup>6</sup></a></li><li>Misperceptions about telehealth contributing to fraud, waste and abuse are not supported by data. A recent Office of the Inspector General report found that only 0.2% of all telehealth providers were “potentially high-risk” for fraud, waste and abuse previously.<a href="#fn7"><sup>7</sup></a> Policies should support the 99.8% of providers safely and compliantly delivering services.</li></ul><h2>Resources</h2><ul><li><a href="/news/perspective/2024-10-18-taking-action-extend-telehealth-and-hospital-home-programs">Taking Action to Extend Telehealth and Hospital-at-home Programs</a></li><li><a href="/lettercomment/2024-03-20-aha-urges-cms-remove-telehealth-provider-home-address-reporting-requirements">CMS Urged to Remove Telehealth Provider Home Address Reporting Requirements</a></li><li><a href="/lettercomment/2023-09-11-aha-comments-cms-physician-fee-schedule-proposed-rule-calendar-year-2024">AHA Comments on CMS’s Physician Fee Schedule Proposed Rule for Calendar Year 2024</a></li><li><a href="/news/headline/2024-04-10-aha-urges-congress-make-telehealth-flexibilities-permanent">AHA urges Congress to make telehealth flexibilities permanent</a></li><li><a href="/2024-08-12-aha-comments-340b-drug-pricing-program-irf-payments-physician-fee-schedule-and-telehealth">AHA Comments on 340B Drug Pricing Program, IRF Payments, Physician Fee Schedule and Telehealth</a></li><li><a href="/2023-10-10-aha-letter-support-senate-connect-health-act-2023-s-2016">AHA Letter of Support for Senate CONNECT Health Act of 2023 (S. 2016)</a></li><li><a href="/lettercomment/2023-01-30-ahas-feedback-senate-re-connect-act">AHA’s Feedback to the Senate Re: The CONNECT Act</a></li><li><a href="/lettercomment/2022-12-01-aha-letter-dea-regarding-request-release-special-registration-telemedicine-regulation">AHA Comments on the SUPPORT for Patients and Communities Reauthorization Act</a></li><li><a href>AHA Letter to DEA Regarding Request for Release of Special Registration for Telemedicine Regulation</a></li></ul><hr><h3>Notes</h3><ol><li id="fn1"><a href="https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-coverage-of-telehealth/" target="_blank">https://www.kff.org/medicare/issue-brief/what-to-know-about-medicare-coverage-of-telehealth/</a></li><li id="fn2"><a href="https://epicresearch.org/articles/telehealth-visits-unlikely-to-require-in-person-follow-up-within-90-days" target="_blank">https://epicresearch.org/articles/telehealth-visits-unlikely-to-require-in-person-follow-up-within-90-days</a></li><li id="fn3"><a href="https://www.aamc.org/media/75236/download?attachment" target="_blank">https://www.aamc.org/media/75236/download?attachment</a></li><li id="fn4"><a href="https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf" target="_blank">https://aspe.hhs.gov/sites/default/files/documents/a1d5d810fe3433e18b192be42dbf2351/medicare-telehealth-report.pdf</a></li><li id="fn5"><a href="https://aspe.hhs.gov/sites/default/files/documents/4e1853c0b4885112b2994680a58af9ed/telehealth-hps-ib.pdf target=">https://aspe.hhs.gov/sites/default/files/documents/4e1853c0b4885112b2994680a58af9ed/telehealth-hps-ib.pdf</a></li><li id="fn6"><a href="https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2020-broadband-deployment-report" target="_blank">https://www.fcc.gov/reports-research/reports/broadband-progress-reports/2020-broadband-deployment-report</a></li><li id="fn7"><a href="https://oig.hhs.gov/oei/reports/OEI-02-20-00720.pdf" target="_blank">https://oig.hhs.gov/oei/reports/OEI-02-20-00720.pdf</a></li></ol></div><div class="col-md-4"><a href="/system/files/media/file/2025/02/Fact-Sheet-Telehealth-20250207_0.pdf" target="_blank" title="Click here to download the Fact Sheet: Telehealth PDF." system files media file><img src="/sites/default/files/2025-04/cover-fact-sheet-telehealth-april-2025.png" data-entity-uuid data-entity-type="file" alt="Fact Sheet: Telehealth page 1." width="695" height="899"></a></div></div></div> h2 { color: #003087; } h3 { color: #9d2235; } Mon, 21 Apr 2025 16:41:00 -0500 Fact Sheets /fact-sheets/2025-04-14-whats-stake-medicaid-covers-people-you-know <div class="container"><div class="row"><div class="col-md-8"><p><a href="/system/files/media/file/2025/04/Whats-at-Stake-Medicaid-covers-the-people-you-know.pdf" target="_blank" title="Click here to download the What's at Stake: Medicaid covers the people you know PDF."><img src="/sites/default/files/inline-images/Whats-at-Stake-Medicaid-covers-the-people-you-know.png" data-entity-uuid="01c577ea-dcda-41cc-8c50-1f1e1bfd8db4" data-entity-type="file" alt="What's at Stake: Medicaid covers the people you know. The majority of U.S. residents with Medicaid coverage are children. 39% of children are covered by Medicaid. Medicaid protects access to care for rural communities. Among Medicaid beneficiaries, 47% of children and 18% of adults live in rural communities. Medicaid supports access to essential obstetrics care, behavioral health services, and primary care. 41% of births in the U.S. are covered by Medicaid. Medicaid provides access to care for low-income seniors. 13.7 million seniors in the U.S. are dually eligible for Medicare and Medicaid. Fact: Medicaid chronically underpays for services. Without supplemental payments, Medicaid fee-for-services payments nationally paid 58 cents for every dollar that hospitals spend caring for Medicaid patients, and Medicaid managed care organizations paid 65 cents. Protect Access to Care: The AHA urges Congress to reject reductions to the Medicaid program that would threaten health care access for patients." width="695" height="900"></a></p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/04/Whats-at-Stake-Medicaid-covers-the-people-you-know.pdf" target="_blank" title="Click here to download the What's at Stake: Medicaid covers the people you know PDF.">Download the Infographic PDF</a></div></div></div></div> Mon, 14 Apr 2025 10:42:17 -0500 Fact Sheets /fact-sheets/2025-04-14-protect-access-care-reject-cuts-medicaid-program-and-premium-hikes-working-families <div class="container"><div class="row"><div class="col-md-8"><p><a href="/system/files/media/file/2025/04/Protect-Access-to-Care-Reject-cuts-to-the-Medicaid-program-and-premium-hikes-on-working-families.pdf" target="_blank" title="Click here to download the Protect Access to Care: Reject cuts to the Medicaid program and premium hikes on working families PDF."><img src="/sites/default/files/inline-images/Protect-Access-to-Care-Reject-cuts-to-the-Medicaid-program-and-premium-hikes-on-working-families.png" data-entity-uuid="c001b8d1-d304-46e2-900b-524456f65c4c" data-entity-type="file" alt="Protect Access to Care: Reject cuts to the Medicaid program and premium hikes on working families. If Congress cuts Medicaid, hospitals would see significant imparts that vary by policy: Per Capita Caps for All Medicaid Population: 1-Year National Hospital Impact in 2026 -$47.6 billion; 10-Year National Hospital Impact through 2024: -$468.1 billion. Per Capita Caps for Expansion Population: 1-Year National Hospital Impact in 2026 -$18.9 billion; 10-Year National Hospital Impact through 2024: -$199.9 billion. Eliminate Enhanced FMAP for Expansion Population: 1-Year National Hospital Impact in 2026 -$32 billion; 10-Year National Hospital Impact through 2024: -$360.6 billion. Reduce FMAP Statutory Floor to 45%: 1-Year National Hospital Impact in 2026 -$7.3 billion; 10-Year National Hospital Impact through 2024: -$78.4 billion. Limit Provider Taxes to 5%: 1-Year National Hospital Impact in 2026 -$3 billion; 10-Year National Hospital Impact through 2024: -$32.8 billion. If the Enhanced Premium Tax Credits (EPTCs) expire: 2.2 million individuals are at risk of becoming uninsured in 2026; 4 million individuals are facing higher costs due to loss of Marketplace coverage in 2026; $705 average per person increase in annual premiums in 2026; -$28.2 billion reduction in spending on hospitals over 10 years." width="695" height="900"></a></p></div><div class="col-md-4"><div class="external-link spacer"><a class="btn btn-wide btn-primary" href="/system/files/media/file/2025/04/Protect-Access-to-Care-Reject-cuts-to-the-Medicaid-program-and-premium-hikes-on-working-families.pdf" target="_blank" title="Click here to download the Protect Access to Care: Reject cuts to the Medicaid program and premium hikes on working families PDF.">Download the Infographic PDF</a></div></div></div></div> Mon, 14 Apr 2025 10:10:24 -0500 Fact Sheets