An association of 200 hospitals and healthcare systems wants Congress to restore upcoming cuts to Medicaid Disproportionate Share Hospital (DSH) funding and appears to imply that it wants those funds reapportioned to help those providers in states that refuse to expand Medicaid coverage per the Patient Protection and Affordable Care Act.

“National Association of Public Hospitals and Health Systems (NAPH) projects hospitals will see $53.3 billion more uncompensated care costs by 2019 than originally estimated when lawmakers approved the Affordable Care Act (ACA),” according to the NAPH statement released last week. During the same period, DSH funding will decrease $14.1 billion.

When the U.S. Supreme Court ruled this summer that Congress could not force states, per the ACA, to expand Medicaid coverage to everyone whose income falls below 133 percent of federal poverty guidelines, it destabilized one of the major compromises of the ACA, according to NAPH. The reductions in DSH funding were to be offset by the expansion of Medicaid, it said.

Exactly how NAPH came up with the $53 billion uncompensated care figure is uncertain, as NAPH declined to show its math. According to the association, “Using data from CBO [Congressional Budget Office], the U.S. Bureau of Labor Statistics, and the American Hospital Association’s annual survey, NAPH applied a per capita uncompensated care dollar figure to the increased number of uninsured (as a result of the court’s decision) to estimate total uncompensated care costs nationally.”

NAPH doesn’t come out and say it, but the statement implies that if the DSH cuts are eliminated, those funds be reapportioned to those states that decline to expand Medicaid. “While the aggregate amount of Medicaid DSH cuts is hardwired into current law, the secretary of the U.S. Department of Health and Human Services has discretion in the distribution of cuts across states,” according to the statement. “Given this discretion, it is crucial for regulatory decisions to address the uncertainties created by the imbalance between anticipated uncompensated care needs and the level of federal support to hospitals that shoulder the majority of this work.”

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