Some groups have modeled out the potential effects if the high court decides that subsidies in the federal exchanges are illegal. For example, the Urban Institute projected that the hospital industry would lose $6.3 billion in revenue, as some insured patients would drop coverage, and bad debt and uncompensated care would rise.
I was curious for a sense of the impact on an individual hospital, and spoke with the researchers who run the Advisory Board's internal "Pleasantville" model—a simulation of an average hospital's finances. They examined the effect on a 338-bed hospital if the subsidized exchange market was essentially knocked out post-Supreme Court decision, and came up with some very rough estimates:
- In Medicaid expansion states, losing exchange subsidies reduces net payment by $1.8 million per hospital, with over $1 million in previous payments now being written off as charity care;
- In Medicaid opt-out states, the result is the same when subsidies are lost—net payment reduces by $1.8 million per hospital and financial assistance increases by $1 million.
To reiterate, these are estimates, just to give a shape for the potential impact. But it's a reminder that a ruling in King v. Burwell affects both Main Street and Wall Street.
Just look to the market for evidence: When news broke on Wednesday that Justice Kennedy appeared skeptical of the case against the ACA, hospital stocks immediately climbed higher.