Greene County General Hospital CEO Brenda Reetz speaks during a virtual news conference about Indiana hospital finances on Tuesday, Jan. 27, 2026. (Screenshot)
By Leslie Bonilla Muñiz
Indiana Capital Chronicle
For The Republic
Hoosier hospitals say they’re increasingly struggling to stay open as expenses rise faster than revenue, according to a new analysis.
“Margins remain quite fragile and somewhat anemic” in Indiana, said Erik Swanson, a managing director at health care consultancy Kaufman Hall, citing results released in a Tuesday news conference.
The analysis, performed on behalf of the Indiana Hospital Association, showed that operating margins at hospitals in the state declined from 2.1% in 2024 to 1.9% in 2025, through August. In the meantime, the national median rose from 1.5% to 2.6%.
“A significant number of Indiana hospitals, particularly rural and safety net hospitals, are operating with little or no financial cushion,” Indiana Hospital Association President Scott Tittle told reporters. “Hospital finances are not abstract. They directly affect patient access.”
“Now, there’s a persistent narrative at the Statehouse and nationally that hospitals are doing just fine,” Tittle continued. “What this report demonstrates is the exact opposite.”
Operating income at Hoosier hospitals declined 5.5% through August 2025 compared to 2024, while operating expenses rose 4.7%. In contrast, income rose 12% nationwide — more than the 6.7% growth in expenses. Medical supply and purchased service expenses were up in Indiana, as were labor costs, despite a nearly 50% decrease in reliance on contract workers.
Conditions are expected to worsen under President Donald Trump’s recently approved One Big Beautiful Bill Act and other factors.
The share of Indiana patients on Medicaid is expected to drop from 20% to 18% by 2030, as is the share on marketplace plans: from 7% to 5%. Meanwhile, the proportion of uninsured patients is projected to go from 8% to 10%. The report predicts the share of patients on Medicare will rise only slightly, from 20% to 21%, and the share with commercial insurance will stay at 46%.
Medicaid and Medicare both reimburse hospitals at a fraction of the cost they spend on care, but hospitals often lose out entirely when caring for patients without any form of insurance.
“As the percent of uninsured individuals rises, uncompensated care will increase, leading to greater pressures on hospital margins,” the report noted.
About 40% of Hoosier hospitals are already operating in the red, Swanson estimated — including several news conference participants.
Greene County General Hospital CEO Brenda Reetz told reporters her southwestern Indiana facility lost $1.4 million last year. The hospital has just 10 days’ worth of cash on hand.
“I get increasingly concerned whenever I hear our legislators and other leaders … villainizing health care for making money,” she said.
Reetz explained that as a county hospital, “no individual” would profit if the facility were to make money. The funds would go to a rainy day account and then be spent on infrastructure. The boilers, she said, are 10 years past their 40-year lifespan, but a new boiler costs about $15 million.
“What if you were never able to tuck anything away in savings? What if you were actually spending more than you were making every month?” she asked. “… That’s the situation that almost every rural hospital in the state of Indiana is facing right now.”
Greene County General Hospital’s obstetrics unit is closing on Sunday, after more than 100 years of delivering babies, because it could no longer absorb the losses incurred on those services.
“We’re going to continue to see more and more cuts like this throughout the state, if something isn’t done — if payers aren’t held accountable, if legislators aren’t held accountable, to ensuring the safety and the future of our safety net hospitals and health care providers throughout the state,” Reetz said.
Several hospital leaders pushed for higher Medicaid and Medicare reimbursement rates, plus greater focus on uncooperative insurers.
Reetz, for instance, said Greene County General Hospital been underpaid by its largest commercial payers, UnitedHealthcare and Elevance Health, for the last two years, with millions more dollars withheld. Elevance was previously known as Anthem.
While United has answered Reetz’s calls and worked with her hospital, she said Elevance hasn’t paid a single claim in the last 90 days — and even clawed back payments for third-trimester ultrasounds from 2023 that the insurer is no longer covering.
“I feel like I’m getting bullied,” Reetz said. “… In any other industry, this would be absurd.”
Tittle, of the Indiana Hospital Association, said several prominent studies and databases rely on “incomplete” claims data or expense types, and “added to this narrative that hospitals are doing just fine.”
“Solutions must be … based on actual claims-paid data and accurate financial analysis,” he said.
— The Indiana Capital Chronicle covers state government and the state legislature. For more, visit indianacapitalchronicle.com.
