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Medicaid Expansion and Disproportionate-Share Hospitals in Red States

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.