Other data sources included CMS MA enrollment data, hospital closures identified from the University of North Carolina Cecil G. Sheps Center for Health Services Research, mergers and acquisitions identified from Irving Levin Associates,16 hospital characteristics from the American Hospital Association (AHA) Annual Survey, financial distress calculated from the CMS Cost Reports,17 hospital market characteristics from the American Community Survey,18 and state Medicaid expansion status from KFF.19 Primary Dependent Variables We examined 2 outcomes: financial distress and closure. ...we examined characteristics of hospitals with high (≥ 20%) and low (< 20%) MA penetration. ...we estimated survival models to quantify the association between MA penetration and hospital closure. ...MA penetration corresponds to 1 year before each event.