"Someone's going to have to blink," he says. "HHS is going to use the disproportionate share issue to the final minute to get the s and years, especially surrounding adjustment of the disproportionate share cuts.
"All of us should be working really hard to educate our governors and congresspeople about the reality of the DSH cuts," Siegel says. "That will take some time. Right now, the reductions are still a few years out—they don't start getting big until after 2016, but in an atmosphere of gridlock, it's hard to get action until a disaster is about to occur."
Of course, if modifications are made to disproportionate share funding to help alleviate the burden on hospitals in states that won't expand, some might see it as a reward for political intransigence.
"If they let the number of uninsured drive the calculation, they'll have to take disproportionate share money away from states like New York and California and give it to states like Texas," Siegel says, "which would be ironic. There are lots of carrots and sticks in play here."
This article appears in the May issue of HealthLeaders magazine.