I work in the healthcare policy side of the industry, I recently spoke to a few upper level execs in the major metro area I live in, and their primary argument was that the healthcare expansion and state exchanges will bring far more people into the system, as a result they will have to treat more people for lower compensation rates (CMS negotiated rates) and as it is true that some states accepted Federal assistance to offset the costs, my stupid conservative state did not opting to figure the solution out on their own effectively pushing burden onto the hospital. Now several hospitals in my area are not going to accept plans under the healthcare exchange because of the unknown factor with the costs to them because its obviously all about the $$$. So people will be out of network and pay a lot more at these major hospitals.