But on a longer-term basis, other hospitals will also be negatively affected.
"All hospitals have skin in this game," says Siegel. "A lot of hospitals maintain their margin because of the safety-net taking the uninsured, and if that goes away, they will bear the brunt. That's not a secret to them, but still a threat."
The haves and have-nots
Though the states that have so far refused still can accept Medicaid expansion, safety-nets in states that refuse expansion are likely to be most at risk.
And though Grady's Haupert expects much to change in coming years surrounding the Medicaid expansion, he and his board are having to make long-term plans to deal with lots of potential challenges. And it's frustrating to them that hospitals are in a political fight they didn't ask for.
"Already we get a disproportionate unfunded mandate. That's our mission and we have some local tax support, but the bigger issue for us is that the way the law is written, you're going to give back 50% of your disproportionate share funding even if they don't expand," Haupert says.
"The diabolical thing is we have an uncertain insurance expansion and a certain cut in disproportionate share," echoes Siegel.
If nothing changes, that would mean huge disparities in how much reimbursement similar safety-net hospitals in other states would get versus hospitals in states like Georgia.
"Many say this is too good of a deal to pass up because if the feds don't deliver on paying for the expansion, you can unwind it," says Haupert. "Our reality, though, is that I don't see us expanding immediately."
For Haupert and his board, that means serious consideration of cuts in services, and with a $45 million annual hole to fill, and it's not idle talk to discuss eliminating money-losing services, like behavioral health, he says.