The legal intricacies of today’s 5-4 decision by the Supreme Court to uphold key provisions of the Affordable Care Act will be parsed for weeks, months and probably years, and will extend far beyond health care. But for hospital executives wondering what it all means for their operations, there are two key pieces emerging at the moment— while the Court upheld the individual mandate as a tax, it may make it difficult for the federal government to withhold existing Medicaid funds from states that refuse to participate in the law’s Medicaid expansion. So while millions of additional paying customers are expected to enter the health care system via the mandate, longstanding concerns about uncompensated care will remain an issue for hospital balance sheets.

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