In a blog for the National Association of Public Hospitals and Health Systems, Bruce Siegel, MD, the group's president and CEO, noted that DSH cuts were "written into the law on the assumption that states would be required to expand Medicaid, leading to fewer uninsured patients landing in the safety net…Without the financial help of an expanded Medicaid program, safety net hospitals absolutely cannot bear further cuts to DSH payments. In an earlier press statement Siegel asked that "policymakers and regulators wade through the Court's decision and clarify the gray areas left in the law, we implore them to revisit the DSH cuts and other hospital-based reductions."
For states that are so far declining to participate in the Medicaid expansion, the reasons for the decision are primarily financial. Although the federal government is committed to picking up the lion's share of the costs for 10 years, states are still cautious.
Anthony Wright, executive director of Health Access, a California advocacy group, says he doesn't understand that stance. "This is a great opportunity for states. There are very few investments that a state might make that could provide a 9:1 return to bolster its health system and economy. There is no tax cut or infrastructure project that provides a 9:1 bang for the buck."