States that forgo Medicaid expansion will lose billions in federal subsidies, money that would have flowed through insurance plans to hospitals, doctors and other providers in the state. Since hospitals are the largest employer in many US counties, I predict significant political pressure for governors to not take the Red State Option. But in addition to the loss of insurance funds, states will lose billions of DSH funding over the next decade. Loss of some DSH was a tolerable bargain when hospitals were promised near-universal enrollment in insurance. But in states opting out of the Medicaid expansion, they will lose significant DSH funding even if Medicaid isn’t expanded and the number of uninsured remains high. In this week’s NEJM, John Graves crunches the numbers and quantifies how much the Red State Option will hurt DSH. More grist for the local political battles already underway.
In a separate NEJM Perspective, Tim Jost catalogs all of the religious freedom cases attacking the inclusion of contraception as a mandatory preventative care benefit for non-grandfathered plans under the ACA. I’ve written about some of these cases previously (Corporations are Catholic too? and More Religious Objections to Contraception Coverage), but Tim covers the cases more comprehensively. Note that in the secular employer cases, the courts aren’t committed (yet) to allowing the corporations to assert 1A rights directly, but rely mainly on the corporation’s purported standing to assert 1A rights on behalf of their majority owners. This issue seems likely to come before the Court in due time.