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Statement on MACPAC Report to Congress


WASHINGTON—America’s Essential Hospitals appreciates the thoughtful work of the Medicaid and CHIP Payment and Access Commission (MACPAC) to examine the relationship between health care coverage and need for federal disproportionate share hospital (DSH) support.

Like MACPAC, we recognize the need for a sustainable, equitable way to support hospitals that serve our most disadvantaged communities. But we must focus first on a more urgent problem: stopping the devastating $4 billion DSH payment reduction set for Oct. 1.

We cannot overstate the threat this cut poses to health care access and to hospitals that care for low-income and other vulnerable patients. If this cut occurs, essential hospitals will be unable to sustain the same comprehensive level of service they now provide to their communities.

MACPAC’s own analysis points to the fundamental inequity of the DSH cuts: Growth in Medicaid shortfall—reimbursement that fails to cover cost—has been larger than the projected decline in uncompensated care under the Affordable Care Act. This finding undermines the very premise of the cuts: that ACA coverage expansion would lessen the need for DSH funding.

On the contrary, the MACPAC analysis shows hospitals that care for Medicaid and uninsured patients still depend on Medicaid DSH payments to meet this mission. To ensure stability for these hospitals and the health and economic vitality of their communities, Congress must act now to stop the October DSH payment reduction.

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About America’s Essential Hospitals
America’s Essential Hospitals is the leading champion for hospitals and health systems dedicated to high-quality care for all, including the most vulnerable. We support our 300 members with advocacy, policy development, research, and education. Communities depend on essential hospitals to provide specialized, lifesaving services; train the health care workforce; advance public health and health equity; and coordinate care. Essential hospitals innovate and adapt to lead the way to more effective and efficient care. Learn more at

Carl Graziano


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