How Hospital Forecasting Just Got Tougher

Interestingly, since Medicaid is funded by both federal and state government programs, the states that opt out of participating in the expansion will also receive less federal Medicaid money. The CBO projects that approximately 6 million fewer people will be covered by Medicaid because of opt-outs.

The opt-out wrinkle makes financial projections essentially guesstimates. The CBO analysts ran different scenarios and settled on numbers "in the middle of the distribution of possible outcomes."

Others are trying to figure out the CBO's breakdown. "We're doing our analysis of the CBO report," says Paul Keckley, PhD, executive director at the Deloitte Center for Health Solutions. "Six states have announced they aren't going to participate in the expansion and there's another 12 states run by 'red state' governors that could opt-out. So, I don't think anyone can predict what's going to happen."

Overall, the CBO and the Congressional Joint Tax Committee now estimate that "fewer people will be covered by the Medicaid program, more people will obtain health insurance through the newly established Exchanges, and more people will be uninsured," the CBO wrote.