Outoffocus docs
Police watch as doctors and other medical professionals stand outside the U.S. Supreme Court on March 26, 2012 in Washington. Hospital lobbyists stand to gain big if states expand Medicaid, but it's going to be a battle. - 

Jeremy Hobson: Well following last week's big Supreme Court ruling on healthcare, states have a choice about whether to expand their Medicaid programs, which provide healthcare to the poor. And a number of them -- including Florida, Louisiana, and South Carolina -- say they won't.

That's worrying for hospitals, as Dan Gorenstein reports from New Hampshire Public Radio.

Dan Gorenstein: John Hawkins is the lobbyist for the Texas Hospital Association, and he expects hospitals to kick in hundreds of thousands of dollars for their lobbying campaign.

John Hawkins: I think it will be as aggressive as anything else we've done. Probably more aggressive.

Why? Hospitals eat costs for the uninsured. In 2010, Texas hospitals swallowed $4.6 billion.

But that argument isn't flying in about a quarter of states. New Hampshire House Speaker Bill O'Brien says, it's just too expensive.

Bill O'Brien: For states to expand Medicaid voluntarily would be like booking tickets on the Titanic.

See how much your state will spend under expanded Medicaid. View an Interactive Map


Hospitals dropped millions in the last presidential election and are big employers. But that's not enough in the reddest states, says Tom Scully former Medicare director.

Tom Scully: I'd be stunned to see Southern conservative governors take the money because I think their conservative base is much stronger than the hospital lobbies are.

Scully says in these states political consequences trump everything else.

I'm Dan Gorenstein for Marketplace.

Follow Dan Gorenstein at @dmgorenstein