While the Supreme Court upheld key pieces of the PPACA in June, the justices struck down as overly coercive the federal government's demands that states expand their Medicaid rolls to millions of Americans who are now uninsured. With the high court's ruling, that expansion now becomes voluntary. At least six states have said they won't extend Medicaid, and another five states have signaled that they may not participate.
If that trend holds true, safety net hospitals estimate that they'll be smacked with about $53.3 billion in uncompensated care costs by 2019. That's because some states won't expand their Medicaid rolls even as the federal government cuts disproportionate share payments to safety nets as part of an agreement etched out in the ACA.
Not unexpectedly, there are signs that the vehement opposition to expanding Medicaid rolls may be cracking. The Wall Street Journal reported in September that several states are looking at a partial expansion of their Medicaid rolls. Expect to read more stories like this in the coming months and years.