J Hosp Health Care Admin, an open access journal ISSN: 2688-6472 1 Volume 5; Issue 01 Journal of Hospital and Healthcare Administration Research Article Kwon IWG and Kim SH. J Hosp Health Care Admin 5: 143. Has the ACA Impacted Charity Care and Bad Debt? Ik-Whan G. Kwon 1* , Sung-Ho Kim 2 1 Saint Louis University, Missouri, USA 2 Yonsei University, Seoul, Korea * Corresponding author: Ik-Whan G. Kwon, Emeritus Professor, Saint Louis University, Missouri, USA Citation: Kwon IWG, Kim SH (2020) Has the ACA Impacted Charity Care and Bad Debt?. J Hosp Health Care Admin 5: 143. DOI: 10.29011/2688-6472.000143 Received Date: 05 December, 2020; Accepted Date: 31 December, 2020; Published Date: 04 January, 2021 DOI: 10.29011/2688-6472.000143 Abstract Objective: To investigate whether the Affordable Care Act (ACA) had an impact on the amount of charity care and bad debt by type of healthcare providers (investor-owned vs. community hospitals), academic affliation (teaching hospitals vs. non-teaching hospitals) and by size of hospitals (small/rural vs. the rest) since 2010. Study Design: This study tests hypothesis that the amount of charity care, bad debt and uncompensated care has decreased as a result of the ACA especially for those states with expanded Medicaid programs. This study uses the secondary data source (2010 to 2015) from California’s Offce of Statewide Health Planning and Development (OSHPD). This study divided the study period into two categories; preparatory period (2010 to 2013) and impact period (2014 to 2105) as the ACA was not fully implemented until 2014. Methods: Simple independent t-test and multivariate regression methods were used to test the hypothesis. Results: Total charity care, bad debt and uncompensated care amount decreased substantially since the ACA. Teaching hospitals and investor-owned hospitals beneftted much higher rates than their counter-part providers. Conclusions: This study explored unchartered areas in the ACA on charity care, bad debt and uncompensated care. Findings are based on California data, which expanded Medicaid coverage as a part of the ACA. It would be an interesting similar study on states that have not expanded Medicaid coverage for uninsured population to observe whether the ACA has a similar impact on charity care, bad debt and uncompensated care. Keywords: Charity care; Bad debt; Uncompensated care; Affordable care act; Multivariate regression analysis What this Study Adds • Most studies addressed how the ACA changed/improved the number of uninsured people since 2010. • This study investigated the impact of the ACA on providers’ fnancial statements in uncompensated care (charity care and bad debt). • This study also shows that the investor-owned hospitals received better outcomes than not-for-proft hospitals and teaching hospitals are larger benefciaries than non-teaching hospitals. Introduction Background The Affordable Care Act (ACA) was signed into law in March 2010. It was designed to extend health insurance coverage to millions of uninsured people. Lower income families can qualify for extra savings on health insurance plans through premium tax credits and cost-sharing reductions. It is claimed that the ACA has had well-documented effects on levels of insurance coverage in the United States, “reducing the numbers of uninsured persons to historically low levels and facilitating increased access to health care services, especially among low-income persons and persons of color” [1]. The most striking provisions in the ACA include prohibiting discrimination against preexisting health conditions and extending health insurance coverage to dependents until they reach 26 years of age. Combined with the individual mandate and insurance- market regulations guaranteeing access to coverage, these reforms are projected to result in coverage of up to 33 million uninsured people by 2022 [2].