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Bad debt does not include charity care or care for which charges were reduced through negotiations.

This would amount to a 49% increase in the time spent collecting Medicare benefits for males and a 33% increase for females.[226] published research that found the Social Security Administration is using an antiquated method to project life expectancies, and as a result, the program “may be in a considerably more precarious position than officially thought.”[227] * The 2017 Medicare Trustees Report projects the future finances of the Medicare program based upon high, low, and intermediate-cost assumptions.[228] Per the intermediate assumptions, the Medicare program faces a .2 trillion actuarial deficit over the next 75 years (in 2017 dollars).

Medicare paid hospitals an average of 13% below their costs of car­ing for Medicare patients, and Medicaid paid hospitals an average of 12% below their costs of caring for Medicaid patients.[102] * As of October 2011, four states limit the number of days that Medicaid will pay for hospital stays: 45 days in Florida, 30 days in Mississippi, 24 days in Arkansas, and 16 days in Alabama.

Arizona and Hawaii are planning to limit the number of days to 25 and 10 respectively.

Spokesmen for hospital associations in Alabama and Arizona have stated that hospitals generally will care for Medicaid patients beyond these time limits regardless of Medicaid’s willingness to pay.[103] * Federal law requires most hospitals with emergency departments to provide an “examination” and “stabilizing treatment” for anyone who comes to such a facility and requests care for an emergency medical condition or childbirth, regardless of their ability to pay and immigration status.

This is mandated under a federal law called the Emergency Medical Treatment and Active Labor Act (EMTALA).[104] [105] [106] * In 2000, emergency room physicians incurred an average of 8,300 in bad debt by providing treatment mandated under EMTALA.

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