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Uncompensated Care Costs Well Down in ACA Medicaid Expansion States

By: Matt Broaddus, Senior Research Analyst at the Center for Budget and Policy Priorities



Hospitals’ uncompensated health care costs, which fell significantly as the Affordable Care Act’s (ACA) major coverage expansions took effect, rose slightly in 2017 but remained well below their 2013 level, according to the latest data from the Medicaid and CHIP Payment and Access Commission — especially in states that adopted the ACA’s Medicaid expansion to low-income adults.

As a share of hospital operating expenses, uncompensated care costs in 2017 were 26 percent lower than in 2013, equating to more than $14 billion in savings in 2017 alone. While uncompensated care costs fell in all states, they fell much more in Medicaid expansion states: by 45 percent, on average, compared to 2 percent in non-expansion states (see table). Expansion states also saw much bigger gains in health coverage.


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