"I imagine most providers came away from this [ruling] thinking they were going to do okay—the worst-case scenario from this is they will get the same amount of Medicaid as they planned for. But how this will play out actually gets very hard to predict," says Freed.
With the door open for states to opt out of Medicaid expansion, it's anyone's guess what will happen in each state, he says. If a state opts out, it would cause residents who fall in the 100%–133% poverty range to seek subsidies for private insurance, which is fully funded by the federal government. However, having to pay for their own insurance may lead many individuals to hold off on getting coverage until it's absolutely necessary.
"If there's no enforcement of the insurance mandate, I can envision people waiting until they are very sick to purchase insurance [through an exchange], and that will drive up the insurance costs and make that insurance pool price very high," he says.