When the Supreme Court last year upheld the Affordable Care Act, commonly known as Obamacare, they ruled that states could decide whether or not to adopt President Obama's expanded Medicaid program. So far, 22 states have either opposed it, spoken out against it or remain undecided.
The controversial provision allows more people to qualify for Medicaid, but also penalizes any insurance-providing company with more than 50 full-time workers whose own workers can't afford insurance. If workers are able to qualify for Medicaid, however, companies can avoid fines of up to $3,000 per individual. So by rejecting the provision, states are making it harder for companies to avoid the penalty.
The study named Texas and Florida employers as those most at risk. Employers in Texas, where Governor Rick Perry rejected the Medicaid expansion and has even called for the law's repeal, are at risk for as much as $448 million in fines.
Florida employers may be forced to pay up a collective $219 million, after Florida Governor Rick Scott's decision to expand Medicaid to more than 1 million people was rejected by the state legislature.
The Congressional Budget Office estimated in 2012 that as many as 6 million people could miss out on Medicaid because the Supreme Court made the expansion optional.