TX, CA, NM, MT, and AK are estimated to receive the largest amounts from the $37.5 billion. Most of the extra dollars they're estimated to receive are due to their large land area, one of several factors used to allocate funds based on state need (7/9).

Additionally, of the $12.5 billion based on measures of need, only 20% is directly based on total rural population (6/9).

Estimated awards from the $37.5B are partially, but not closely, tied to rural population. E.g., TX has the most rural residents in the nation (4.3M) but is estimated to only receive about twice as much as RI, which has the fewest (about 25,000) (4/9)

Estimated awards from the $37.5B range from $550 million in Rhode Island to just over $1 billion in Texas over five years if all states are approved for funding (3/9).

The analysis examines $37.5B of the $50B fund: $25B to be distributed equally across states with approved applications (as required by law) and an additional $12.5B to be distributed based on measures of state need (as specified primarily by CMS) (2/9).

Urban hospitals that serve a large share of Medicaid patients have been left out of the conversation and without support from the fund, though many are already in the red. These hospitals could also have a hard time absorbing any losses under the bill (4/7)

One of the biggest flashpoints for the "One Big Beautiful Bill Act" has been its impact on roughly 1800 rural hospitals, which is why Senate Republicans are proposing a new $15 billion rural health fund. However, there are still questions and concerns about the bill 👇 (1/7)

Operating margins varied across states, which could reflect a variety of unique circumstances facing hospitals across the country, such as demographics, hospital ownership and cost structure, commercial reimbursement rates, and state and local health and tax policy.

Operating margins were also higher than average among hospitals with high prices, especially among those that also had high commercial shares.

In contrast to rural and high Medicaid share hospitals, operating margins were higher than average among hospitals with a relatively large share of commercial patients, system-affiliated hospitals, and (especially) for-profit hospitals.

Operating margins were lower than average among rural hospitals and hospitals with a relatively large share of Medicaid patients.

However, some hospitals struggled more than others in 2023, with about two in five (39%) having negative operating margins.

We evaluated hospital margins and found that they rebounded in 2023 following a large decrease in 2022.