The Certainty of Uncertainty

Joe Fifer, president and CEO of  the Healthcare Financial Management Association, says the ruling created "more uncertainty for CFOs than if it had been shot down altogether.

"Many of us are wondering what the implications of this will be on Medicaid—it's a big question mark," Fifer says. "We can't be sure how many uninsured people it will impact until each state decides what to do. The only thing we can presume is that there will be more activity toward establishing [insurance] exchanges in each state."

A provider view on Ohio's situation comes from Mary Ann Freas, CFO at Southwest General Health Center, a private, nonprofit, 354-bed facility located in Middleburg Heights, Ohio. "I don't know if we will or won't participate, but I do know that if they don't [opt in], it's going to put more burden onto the safety-net hospitals," she says.

If the state opts not to participate, "the safety-net hospitals that have a great deal of uninsured will lose their disproportionate share and that will hurt. I'm not sure that's something that [the state] can politically get away with."

Freas says uncompensated care at Southwest General is 4% of net revenue, but she's unclear how the Supreme Court's ruling will affect her organization's Medicaid payments and payer mix. For forecasting purposes, though, Freas is assuming that Ohio will participate in the expanded Medicaid program, which will cause her organization's uncompensated care levels to decline while Medicaid numbers will increase.