The implementation of the Patient Protection and Affordable Care Act (ACA) is changing hospital reimbursement in important ways. The most significant changes stem from increasing access to health insurance coverage for previously uninsured or under-insured populations. Since rural residents are more likely than urban residents to be uninsured, increased access to health insurance should, in theory, provide a new source of revenue for rural hospitals and, therefore, improve financial performance. However, the ultimate financial impact of the ACA on rural hospital providers is still unknown. To better understand how the ACA’s expansion of insurance coverage has affected uncompensated care, unreimbursed cost, and financial performance in rural hospitals, the NC Rural Health Research Program interviewed rural hospital administrators, state hospital associations, and State Offices of Rural Health (SORHs).
In the brief, Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?, we summarize and present responses about perceptions of changes in payer mix, changes in uncompensated care (bad debt and charity care) and unreimbursed cost (shortfalls between the costs of providing services and payments by public programs) and financial performance in their respective hospitals/state.