By extending health insurance to millions more people, the Affordable Care Act could make it harder for nonprofit hospitals to maintain their tax exemptions, says Forbes.

Hospitals in many states already face public and political pressure over the amount of free and discounted treatment they provide, a key factor in regulatory proceedings to determine if they offer sufficient community benefit to justify their tax breaks.

With far fewer uninsured people, the amount of charity care hospitals provide is likely to fall further, potentially making it harder for them to maintain nonprofit status, Forbes notes. The article cites two options for dealing with the issue: a wave of conversions to for-profit status or broader community-benefit standards that take into account services other than free care for uninsured patients.