Abstract
Using hospital cost report data from the Centers for Medicare and Medicaid Services, we examined the changes in hospitals' operating margins and total margins between 2019 and 2021. We found that, as of 2021, hospitals' operating margins had not fully rebounded to 2019 levels, although they had recovered from the 2020 nadirs. Conversely, average total margins increased by 140% during this period across all US hospitals, with the most significant growth occurring among rural hospitals, publicly operated hospitals, and critical access hospitals. Rural hospitals exhibited the largest gains in total margins during this time, experiencing a 1600% increase from 2019 to 2021. Our findings indicate that government relief funding tied to the COVID-19 Public Health Emergency significantly bolstered the financial health of the average hospital and had an outsize effect on lifting total margins among smaller hospitals that entered the pandemic in the most financially vulnerable position.