Has the decision to expand or not to expand Medicaid impacted merger and acquisition activity among hospitals and health systems? With only two years’ worth of data (2014 and 2015), it’s still early to draw definitive conclusions. So consider the following data as anecdotal evidence of the economic impact the various state governments have brought to bear on healthcare providers in their states.

Mergers and acquisitions among all types of hospitals—acute care, long-term care, critical access, etc.—in the Medicaid expansion states increased from 49 deals in 2014 to 56 deals in 2015. Hospitals and health systems based in non-expansion states saw M&A activity decrease in the same time period, from 45 deals to 37.

The number of hospital targets that were involved in bankruptcy proceedings also showed marked differences. Among states that expanded Medicaid, four out of 49 transactions involved a bankrupt hospital in 2014. That figure dropped to a single hospital in 2015. Of the states that did not expand Medicaid, two out of 45 deals had a bankrupt hospital as a target in 2014. By 2015, six of the 37 transactions were for an insolvent facility.