In the Supreme Court's ruling last summer, it upheld the ACA, but gave the states the option of whether or not to participate in Medicaid expansion. For hospitals, that meant a big source of necessary funding was suddenly in jeopardy. In states like Arkansas, where many Republican lawmakers campaigned on an anti-Obama-care platform, hospitals are worried about harmful cuts in service—and even fear for their survival—if the legislature says no to expansion of coverage. Hospitals are feeling even more vulnerable after the "fiscal cliff" deal in January that slashed reimbursement rates even more, with Arkansas hospitals projected to take an additional cut of more than $400 million.