The Supreme Court greenlit continued HHS use of a payment formula for Medicare disproportionate share hospital (DSH) payments, which has cost hospitals $1.5 billion annually.
The decision allows continuation of a policy that counts patients in the numerator of the Medicare fraction only if they receive Supplemental Security Income (SSI) cash benefits during the month of a hospitalization.
Per estimates, HHS’s interpretation cuts DSH payments by 15%, or roughly $1.5 billion annually, when extrapolated nationwide.
Hospital emergency department (ED) volumes have jumped 40% since 2020, according to a recent Moody’s Ratings report.
Other data found:
15% increase in year-to-date 2025 ED visits per calendar day compared to YTD 2022
20% increase in ED volumes from 2000 to 2018
45.3% of ED visits were covered by Medicaid in 2021
Some states and hospitals have blamed the ED surge on a recent immigration wave and post-COVID Medicaid eligibility redeterminations. But an ED researcher credited the surge to a sicker, older population that needs the intensive services only EDs can provide.
Emergency department surge
ED volumes have increased 40% in a recent five-year span among a group of hospitals tracked by Moody’s Rating Services.
Source: Moody's Ratings, Not-forProfit and Public Healthcare - US Preliminary medians - Revenue growth drives improved profitability, April 3, 2025
Where commercial patients struggle most with affordable care
People covered through employer-sponsored insurance in rural states face the biggest insurance costs, according to a recent analysis.
However, comparing 2023 employee premium contributions and deductibles relative to state-wide median income revealed some southern states had the worst affordability.
The states with the least affordable ESI family coverage included:
Louisiana (14.9% of income)
Oklahoma (13.5%)
New Mexico (13.3%)
Alabama (12.9%)
Florida (12.6%)
Residents of 22 states spent more than 10% of their incomes on ESI premium contributions and deductibles for family coverage together in 2023.
Thanks to the recent inflation-driven increase in wages, the national average of the share of income consumed by ESI premiums and deductibles decreased from 10.8% in 2020 to 10.1% in 2023.
Where job-based insurance costs are highest
The total combined average of premium and deductibles for family coverage enrollees in employer sponsored insurance viewed widely by state.
Source: Commonwealth Fund, How Affordable Is Job-Based Health Coverage for Workers?, March 13, 2025
To help readers keep track of the wave of healthcare policy initiatives from the Trump administration and Congress, here is a timeline of federal actions and HFMA’s related coverage.
