We usually think that a high Medicaid payer mix is indicative of lower profitability and value. But slower payments and higher defaults shift the focus to private pay/self-pay being the bigger problem in many regions. Many hospitals are already in distress, especially the smaller community hospitals. This will just exacerbate the problem.
Additionally, Crowe noted in its study the rising popularity of high-deductible health plans. The study estimates the average hospital in a Medicaid expansion state could see their self-pay payer mix increase by 4.2 percent with both a repeal of the ACA and the rise in popularity of high-deductible health plans. Crowe said this is expected to lead to a 2.8 percent decrease in total net revenue for these organizations.