WASHINGTON — Essential hospitals, more than 300 of the nation’s largest safety net providers and about 5 percent of all U.S. acute-care hospitals, provided more than a quarter of all charity care nationally in 2021, a new report from America’s Essential Hospitals shows.

The report, Essential Data 2023: Our Hospitals, Our Patients, also shows that charity care and other uncompensated care left essential hospitals in the red, with an average operating margin of −8.6 percent compared with −1.4 percent for all other hospitals, based on Medicare cost report data.

“These data show how the added pressure of the pandemic deepened long-standing financial challenges for our hospitals, including public payer shortfalls and the high uncompensated costs of their safety net mission,” said Beth Feldpush, DrPH, senior vice president of policy and advocacy for America’s Essential Hospitals. “Those challenges remain today and underscore the urgency of stopping cuts to key federal safety net support.”
Medicaid disproportionate share hospital (DSH) funding is set for an $8 billion cut in mid-November, when the current stopgap government funding measure expires. This amount, two-thirds of all federal DSH dollars, would devastate essential hospitals, Feldpush says.

“They simply cannot sustain a cut of that magnitude,” she says. “Access to care and lifesaving services will suffer unless Congress acts.”

The association’s latest data report, a snapshot of its members, shows that people from underrepresented racial and ethnic groups constituted about 55 percent of member discharges in 2021 and nearly three-quarters were uninsured or covered by Medicaid or Medicare. The report also illustrates the socioeconomic status of essential hospitals’ communities, where 5.4 million people had limited access to healthful food, 237,000 experienced homelessness, 10 million had no health insurance, and 14.6 million lived below the poverty line in 2021.

“Essential hospitals are on the front lines of work to address social and economic factors that drive poor health,” Feldpush said. “They understand that health — good and bad — begins outside their walls, in the community.”

Essential hospitals extend their reach with a median of 16 on- and off-campus ambulatory care centers per hospital, including rural health clinics and federally qualified health centers. These networks, which bring care to historically underserved people, would suffer under legislative proposals that disregard the added costs hospitals sustain to operate clinics, Feldpush says.

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