Study shows further Medicare expansion could diminish hospital revenues

Hospital and health systems should remain aware of the financial impact that several Medicare expansion proposals could have on their respect organizations, according to a new study from Navigant.

Candidates for the 2020 presidential election are heralding sweeping policy proposals to expand coverage through Medicare. While several versions of Medicare for All legislation exist, other policy proposals such as 'Medicare for more' or the public option have drawn consideration from lawmakers as potentially more viable or pragmatic solutions to America's healthcare problems.

In its analysis, Navigant found a medium-sized, nonprofit, multi-hospital system with revenues of more than $1 billion and a current operating margin of 2.3% would endure vastly different financial implications under several proposed federal healthcare policy changes.

Medicare for All would reduce revenues by around $330 million, a margin drop of just over 22%, the public option proposal would cause revenue declines in the neighborhood of $153 million, a margin impact of -6.3%, and the 'Medicare for more' expansion plan is estimated to have a neutral impact compared to the status quo.

Still, Navigant's study points out that if Congress does not act on Medicare expansion until after the next presidential election, hospitals could face a scenario with a financial impact comparable to the public option proposal.

Using the model health system as an example, status quo projections without any cost reduction initiatives would see the organization's net margin decline from 2.3% to negative 6.2% from 2018 to 2023, with operating costs rising between 4.5% to 5% per year and revenues growing at 2.5% to 3% per year.

Medicare for more

• Voluntary buy-in at age 50 and over
• In one scenario, choice between employer coverage and Medicare
• No Medicare payment relief
• No reduction in revenue cycle management operations compared to the status quo
• 15% reduction in current disproportionate share hospital payments

Public option

• All lives covered regardless of age
• Choice between employer coverage and Medicare
• Range from no Medicare payment relief to payments at 110% of Medicare rate
• 1.5% reduction in revenue cycle management operations compared to the status quo
• 70% reduction in current disproportionate share hospital payments

Medicare for all

• All lives covered regardless of age
• Single payer healthcare coverage
• Range from no Medicare payment relief to payments at 120% of Medicare rate
• 2.5% reduction in revenue cycle management operations compared to the status quo
• 100% reduction in current disproportionate share hospital payments

The analysis arrives at the early part of the conversation surrounding widespread Medicare expansion at the federal level, which makes it difficult to gauge how health system leaders will react to Navigant's findings.

Some may be hesitant to support plans that are projected to create such a negative material impact on their respective bottom lines, but others may be willing to consider a policy proposal that significantly decreases or even eliminates bad debt costs associated with a large uninsured population.

Even before the report was released, however, the American Hospital Association declined to voice support for Medicare for All late last month.