Fitch: Uncompensated care could increase next year under ACA

Without modifications to the ACA, exchange enrollment could suffer and hospitals are likely to see uncompensated care rise next year, according to Fitch Ratings.

Last Friday, the GOP's proposal to repeal and replace the ACA was pulled from the House floor, leaving the ACA in effect for the time being.

Hospitals are not expected to see a rise in uninsured patients this year since those enrolled in an ACA plan for 2017 will keep it, Fitch said in a news release. However, with premiums rising and insurers leaving the exchanges, ACA enrollment is likely to decrease, the agency noted. Total signups for open enrollment fell 4 percent from 2016 to 2017.

"The failure of the AHCA [American Health Care Act] to move forward means that the ACA exchanges will be ostensibly functioning in 2018, but hospital companies will likely face higher levels of uncompensated care as fewer individuals enroll in exchange products," Fitch said.

Still, Fitch said it is the ACA's Medicaid expansion — not the exchanges — that have primarily driven a decrease in uncompensated care for hospitals.

"The AHCA's changes to the ACA related Medicaid expansion were relatively more benign than the expected dislocation in the exchange covered lives with respect to the ultimate influence on hospital companies' patient payer mix and the financial burden of treating uninsured patients," Fitch said. "However, while current Medicaid enrollment is likely to be stable, more states will not likely expand eligibility given the uncertainty of future funding."


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