For the past two weeks, we have examined the Patient Protection and Affordable Care Act (ACA). This week we will discuss some of the impacts it could have on Alabama.

The federal government cannot force states to participate in programs or follow certain guidelines, but it can withhold funding. Think of it as the carrot at the end of a stick enticing states to do what the federal government wants them to do.

Under the ACA the state is tasked with establishing a health insurance exchange. This exchange is a marketplace for individuals to comparison shop for insurance policies from competing private companies. This marketplace is for people that do not have insurance through the government or an employer. Alabama has a Nov. 16 deadline to submit a blueprint for its exchange. If Alabama, or any other state, does not create an exchange, the federal government can step in and create one.

One of the provisions of the ACA increases Medicaid eligibility so that more people are included. Originally, this Medicaid expansion was to be federally mandated. Anyone under 65 with an income of less than 133 percent of the federal poverty level would have become eligible for Medicaid in 2014. This would include individuals making $14,856 and a family of four bringing home $30,657.

As it stands, states can choose whether or not to expand their Medicaid rolls.

Originally, the ACA specified that state funding for Medicaid programs would be cut if the states did not expand their programs under the ACA. This would effectively bankrupt the states in question. However, the Supreme Court struck down that provision. According to the majority opinion existing Medicaid funds cannot be cut; but if a state opts out, the state would not get the additional funding offered under ACA.

If Alabama decides to expand its Medicaid program, the federal government would pay for 100 percent of the cost of services for the new enrollees for the first three years. After three years, that contribution would drop to 90 percent. While this does not sound like much of a drop, it could potentially cost the state millions of dollars. Some estimates put Alabama paying more than $100 million a year to continue the new expanded program. The problem for the state is that it struggles to fund the current Medicaid program.

If Alabama decides to expand Medicaid, the state would receive $10 billion to $11 billion in federal matching money that would be spent in pharmacies, doctors' offices, and nursing homes. This is a lot of money potentially put into the state's health care industry; however, many leaders still believe that it will cost the state too much in the long run.

What will Alabama do? We will all just have to wait and see.