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    Supreme Court Upholds Health Reform Law

    What will the states do? Are many of them likely to refuse the money to expand Medicaid coverage? continued...

    Marc K. Siegel, MD, a clinical associate professor of medicine at NYU Langone Medical Center in New York, says many states are already struggling to pay for Medicaid costs.

    "I think states will turn it down. I don’t know how many out of the 26, but I think they will," Siegel says. "California is in a lot of trouble right now. Florida is in trouble. New York is in some trouble. In New York, it's a billion dollars or more to administer the Medicaid expansion. So a key problem here is not in terms of Medicaid, which the feds are picking up the cost of for the most part, but the administration of the additional Medicaid patients."

    Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va., says the Medicaid ruling is "a really, really important decision because you've got a lot of conservative governors saying you can't force us to expand Medicaid this way, we can't afford it."

    "The political consequences of that are to say to these conservatives, 'Put up or shut up.' If you don’t want to expand Medicaid in your states, you don't have to. Take the political consequences for that. I think that is a really huge thing to be saying to these conservatives who don't want anything to do with the ACA. 'Put up or shut up.' This is a big deal. You don't want the money, you don't have to have the money, but then you go face your constituents and tell them why you didn't expand Medicaid like the other states," Laszewski says.

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