“The shutdown on April 1 serves as an early warning for hospitals in states such as Louisiana, where Republican Gov. Bobby Jindal turned down federal money to expand the Medicaid program for the poor,” Bloomberg reports. “Charity hospitals will lose billions of federal aid beginning late next year, a cut that was supposed to be offset as more residents were covered by Medicaid.”

While Republican governors in states including Indiana, Ohio and New Jersey have expanded their Medicaid programs under Obamacare, Jindal has remained steadfast in his opposition. The governor has said adding to the federal program would put almost half of Louisiana on government assistance. Jindal instead decided to turn management of the state’s charity hospitals over to private operators, a step his administration says has resulted in reduced wait times and better care at a lower cost.

“Instead of expanding Medicaid, we have chosen to improve health care and expand access for all Louisianans by transforming our state-run charity hospital system,” Shannon Bates Dirmann, a spokeswoman for Jindal, tells Bloomberg an email.

Kathy Kliebert, the secretary of Louisiana’s Department of Health and Hospitals, also tells Bloomberg that the Baton Rouge General’s financial issues in Mid City preceded the Medicaid decision and changes to the state hospital system. She says it was undermined by market forces as rival specialty hospitals lured away insured patients.

In Louisiana, Obamacare would have added 242,000 to the program, according to the Kaiser Family Foundation, a Menlo Park, California-based nonprofit that tracks health-care policy. Nationwide, charity hospitals are set to lose money from a Medicaid fund that partially offsets the cost of treating those who can’t pay.

Read the full Bloomberg feature.