Skip to Main Content
Don't have an account? Create Account
Don't have an account? Create Account

Essential Hospitals Face Significant Losses Without Comparable ACA Replacement

WASHINGTON — If Congress fails to replace the Affordable Care Act (ACA) with a comparable plan, coverage losses and scheduled cuts to hospital funding would total up to $40.5 billion nationally for hospitals that fill a safety-net role, a new analysis shows.

That number represents coverage lost from an ACA repeal and cuts to Medicaid disproportionate share hospital (DSH) funding and Medicare from 2018 through 2026, the analysis by America’s Essential Hospitals shows. The association represents nearly 300 of the nation’s largest health systems dedicated to caring for low-income and other vulnerable patients.

Even if congressional ACA opponents followed their December 2015 repeal blueprint—a plan that would have rescinded the Medicaid DSH cuts—essential hospitals still would face a $16.8 billion loss over the same period, the association said in a new policy brief.

“These numbers really show what’s at stake for the patients who depend on the doors being open at essential hospitals,” said Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals. “These are unsustainable losses that would jeopardize vital services and access to care in communities across the country.”

America’s Essential Hospitals also calculated that other funding shortfalls, such as below-cost Medicaid payments, and losses from a standalone repeal of the ACA would translate to $54.2 billion in uncompensated care costs for its members over 10 years, starting in 2019.

“Our members already face heavy financial challenges,” Siegel said, noting that the association’s members operate, on average, with a zero margin and provide nearly 20 percent of the nation’s total uncompensated care. “Neither they nor their patients can afford anything less than a full, comprehensive replacement at the same time as repeal.”

America’s Essential Hospitals recently released principles for health care reform in light of the repeal and replace debate. The association urged policymakers to pair a repeal of the ACA with a simultaneous, comprehensive replacement. Any action less than an immediate replacement also must reverse the ACA’s cuts to hospital payments. Whichever direction policymakers take, they must ensure that patients can maintain coverage during the transition to a replacement plan, the association said.

Today’s policy brief, ACA Replacement Must Protect Vulnerable People, Communities, is the first in a series of papers from America’s Essential Hospitals that examine how an ACA repeal and replacement could impact essential hospitals and patients.

# # #

About America’s Essential Hospitals
America’s Essential Hospitals is the leading association and champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. Since 1981, America’s Essential Hospitals has initiated, advanced, and preserved programs and policies that help these hospitals ensure access to care. We support members with advocacy, policy development, research, and education.

Our nearly 300 members are vital to their communities, providing primary care through trauma care, disaster response, health professional training, research, public health programs, and other services. They innovate and adapt to lead the broader health care community toward more effective and efficient care. Learn more at

About Essential Hospitals Institute
Essential Hospitals Institute is the research and quality arm of America’s Essential Hospitals. The Institute supports the nation’s essential hospitals as they provide high-quality, equitable, and affordable care to their communities. Working with members of America’s Essential Hospitals, we identify promising practices from the field, conduct research, disseminate innovative strategies, and help our members improve their organizational performance. We do all of this with an eye toward improving individual and population health, especially for vulnerable people.

Carl Graziano


About the Author

Dedicated staff at America's Essential Hospitals work together to produce high-quality, reliable content. Please view the about section for more details about staff.

Previous Next
Test Caption
Test Description goes like this