The issue is a hot button one for hospitals, whose leaders worry that in states that don't expand their Medicaid programs, millions of patients will remain uninsured, as if the PPACA had never existed. That would require hospitals to shoulder the costs of care when patients need it emergently.
Meanwhile, these hospitals are shouldering billions in reimbursement cuts and reduction in disproportionate share funds that they agreed to in anticipation that all states would expand their Medicaid programs.
Joy Wilson, health policy director at the National Conference of State Legislatures, the group holding the meeting where Mann spoke, said lawmakers in attendance seemed interested in the new option. "There was some comfort in that if they were if their states decided to do the expansion, and for whatever reason it didn't work out fiscally, they would have an option to reverse that course," she says. "There was some feeling that was a good thing."
Wilson adds that many states "just don't know what they're going to do yet because they don't have all their facts in front of them."
One particular sticking point remains in what Salo and others call "the moving parts."