With Chief Justice John Roberts's utterly lawless claim in NFIB vs. Sibelius that the Medicaid expansion in the ACA is not part of Medicaid but rather a completely new federal-state opt-in program, the combination of ideological Republicans in the states seeking to demonstrate their allegiance to the party line and the structure of the rest of the ACA has put America's red-state safety-net hospitals in a huge amount of trouble.
Below the fold, Ann Marie Marciarille:
Missouri State of Mind: The New Medicaid Expansion Opt-In and Disproportionate Share Hospitals: [O]ne of the most widely discussed ACA provisions has always been the re-invention of the treatment of disproportionate share hospitals (DSH) under the ACA…. What is DSH?… DSH is a system of… payment adjustments… offer[ing] federal funds to… hospital[s] that disproportionately serves the uninsured…. Pegged to Medicaid eligibility, Medicaid DSH payments always… [had] incredibly uneven geographic distribution. Under the ACA's planned federalization of Medicaid's eligibility standards, this was to stop…. The federalization of Medicaid [that was to fill the gap created by the end of DS payments] was specifically struck down in NFIB v. Sebelius. Even if you are among the camp that thinks a majority of states will eventually opt-in to Medicaid expansion (as I am)… [it] will necessarily [not] be speedy or pretty. In the meantime, the squeeze will already be on Medicaid DSH payments.
So, hospital administrators in Kansas and Missouri must be afraid. Very afraid.