This Georgia hospital shows why rejecting Medicaid isn’t easy.

The Affordable Care Act was originally written such that every state would have to accept a Medicaid expansion. But the Supreme Court struck down that part of the law last year. The result is an unexpected bind for safety-net hospitals in states that are refusing Medicaid. How bad of a bind? Just look at the choices facing Atlanta’s Grady Memorial Hospital.

Grady, Georgia’s largest hospital, with more than 950 beds, has long been considered the backbone of metro Atlanta’s health-care system. It serves about 600,000 patients every year, trains one-quarter of Georgia’s physicians and provides medical care to more uninsured patients than any other hospital in the state.

But like a number of other safety-net hospitals nationwide that provide uncompensated care to uninsured patients, Grady may be forced to make service cuts in light of Georgia’s refusal to expand its Medicaid program.

The state’s leaders have steadfastly opposed expanding Medicaid since expansion became an option last summer. Because of that development, Grady officials say that the Affordable Care Act could now be the worst thing to happen to the hospital — an 121-year-old institution that’s all too familiar with financial struggles.

As part of the original Affordable Care Act passed by Congress in 2010, Disproportionate Share Hospital payments — DSH for short — were supposed to be gradually reduced by an estimated $17.1 billion between 2014 and 2020. Public hospitals have long relied on federal DSH funds to offset the costs of treating a large number of uninsured patients. Requiring states to expand their Medicaid programs would have brought in new money that more than offset the DSH cuts.

But things turned in June 2012 after the Supreme Court left it up to states to determine whether they wanted to expand Medicaid. Some conservative state leaders, including Georgia Gov. Nathan Deal, quickly and staunchly rejected what they viewed as another growing entitlement program.

via This Georgia hospital shows why rejecting Medicaid isn’t easy..