Texas is one of those  Red States that refused to expand Medicaid under the Affordable Care Act. So at least partly because of that, three big not-for-profit Texas hospital systems are being hammered by a huge increase in bad debt and charity care.

Together, Texas Health Resources, Baylor Scott & White and Methodist Health, three of the largest health systems in the Dallas region,  had almost $1.9 billion in uncompensated care last year, up 81 percent since 2013, the year before the ACA took full effect.

In response, reports the Dallas Morning News, hospital executives are reducing  the number of workers, “outsourcing more contracts and trying to hold down supply costs. ” The   squeeze could also discourage investment in facilities and services, especially those needed in low-income areas.

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