Nevertheless, several Republican Senators, including those from Missouri, Nebraska, Mississippi, and Idaho, have already declared that their states would likely turn down new federal money to expand Medicaid. One reason cited is the difficulty of picking up their share of the program once the government's portion decreases to 90% of costs. The ruling will likely spark continued political clashes in at least 26 states—primarily those that sued to overturn the law.
"Today's ruling underscores the urgency of repealing this harmful law in its entirety," House Speaker John Boehner, R-Ohio, told the press. While Ohio hasn't announced a decision on adoption of the expanded Medicaid coverage, with a Republican governor in office and a November Presidential election on the horizon, it's quite possible.
A provider view on Ohio's situation comes from Mary Ann Freas, CFO at Southwest General Health Center, a private, not-for-profit, 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."