By Bernie Tokarz While lawmakers in Washington debate the nuances of broader health care policy, uninsured Americans are still turning to local hospitals to... Congressional inaction on DSH program will hurt Georgia hospitals

By Bernie Tokarz

While lawmakers in Washington debate the nuances of broader health care policy, uninsured Americans are still turning to local hospitals to access basic care, and those hospitals are still on the hook for the costs of that care. And if Congress doesn’t act by the end of September, funding for the program that helps keep these hospitals open will lapse, affecting dozens of hospitals across Georgia.

Costs of care not covered by Medicaid, Medicare or private insurance have a significant financial impact on hospitals. This impact is mitigated in large part thanks to the Medicaid Disproportionate Share Hospital (DSH) program, which provides crucial funding to hospitals to help offset these uncompensated care costs. Without this critical funding, hospitals might have to stop providing services, lay off staff, or raise costs.

Though the DSH program is a crucial part of keeping safety-net hospitals open and running, the 116th Congress has neglected to make funding for it a legislative priority. If Congress does not take action soon, $7 billion in cuts to the DSH program will go into effect on Oct. 1.

President Ronald Reagan created the DSH program in 1985 to support hospitals that serve a disproportionate number of uninsured patients and low-income patients. The Affordable Care Act (ACA) of 2010 called for a reduction in DSH program funding, on the assumption that Medicaid expansion would reduce the number of uninsured Americans. The logic was that hospitals would need less DSH funding as the rate of Americans without health insurance dropped. However, for various reasons (such as some states declining expansion), the drop was not as great as anticipated, necessitating a postponement of the scheduled reduction.

While the national health care debate often deadlocks along partisan lines, the DSH program enjoys support from both sides of the aisle. Our U.S. senators from Georgia — Johnny Isakson and David Perdue –have worked hard to keep this needed funding from lapsing. Congress first delayed implementation of the cuts in 2013 in an overwhelmingly bipartisan vote, and has delayed them each year since, most recently in the budget agreement passed in 2018. However, time is running out this year.


In Georgia, DSH cuts would have an enormous impact on hospitals serving lower-income people. Georgia’s current annual DSH allotment is $468.6 million, which 134 hospitals rely on to keep their doors open and provide quality care to low-income patients. If Congress fails to delay cuts soon, Georgia hospitals stand to lose $108.3 million in funding the first year – a whopping 23 percent reduction in funding – and double that amount the following year.

These cuts are simply unsustainable for safety-net hospitals and would force them to cut services, raise rates, or both, resulting in higher premiums, job losses, and in some cases, hospital closures. Lower-income Georgians who depend on their local hospitals will be forced to find care elsewhere or pay more for the care they need, and communities whose economies rely on local hospitals will suffer. Health care leaders, advocacy groups, and industry experts all widely oppose DSH cuts and agree that Congress must take action to delay them.

As partisan politics dominate Washington, delaying DSH cuts is one issue that leaders from both parties can and should agree on. However, in just a relatively few days, the most vulnerable of Americans and the hospitals they rely on will have to reckon with the adverse effects of bipartisan inaction. Why continue delaying what can be dealt with now? With continued uncertainty about funding worrying consumers and providers alike, our congressional delegation must work now – not later – to ensure continued funding for the DSH program and its vital support for Georgia hospitals and patients.

Bernie Tokarz is a Trustee of the Fulton-DeKalb Hospital Authority.

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