"Furthermore, significant uncertainty remains over the future of U.S. healthcare policy given the size of the federal budget deficit, which has increased since the passage of PPACA in April 2010," Moody's said. "For not-for-profit hospitals, which account for the vast majority of American hospitals, this uncertainty continues to heighten credit risk in an already pressured operating environment."
Causing more uncertainty for not-for-profit hospitals was the Supreme Court's concurrent ruling last month that removed penalties for states that refused to expand their Medicaid programs under PPACA. So far, the governors of Florida, Louisiana, Texas, South Carolina, and Mississippi have said they will opt out, and the governors of five other states have signaled that they are leaning that way.
"I stand proudly with the growing chorus of governors who reject the Obamacare power grab," Texas Gov. Rick Perry said this month in a letter to Health and Human Services Secretary Kathleen Sebelius. "Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to healthcare."
It's worth noting the grandstanding hyperbole in these election-year pledges to reject billions of dollars in federal money. Observers have noted that much of this opposition will quietly melt away after the polls close in November.