NAPH said $14.1 billion in Medicaid disproportionate share hospital (DSH) reductions were supposed to be balanced by a nationwide Medicaid expansion. But the Supreme Court’s ruling allowed states to forgo the expansion, and NAPH’s new projections show that increasing uncompensated care costs through 2019 by $53.3 billion more than expected before the ruling.

“Congress certainly didn’t foresee this level of uninsured and uncompensated care when it enacted the ACA,” said NAPH President and CEO Dr. Bruce Siegel. “In this light, the deep cuts to DSH payments over the same period are simply untenable and will prove devastating to society’s most vulnerable and to the providers who care for them.”

Consequently, NAPH said, “We believe DSH funding cut by the ACA should be restored.”

NAPH also expressed particular concern about safety net hospitals and noted that the U.S. Department of Health and Human Services has discretion in the distribution of the DSH cuts across states.