The penalty for not buying into health insurance may be higher than patients thought.

Modern Healthcare notes that the Affordable Care Act is driving some hospitals to reconsider their charitable medical coverage, in the form of either denying service for insurance-eligible patients who declined to enroll, or adding a non-insurance fee if patients were eligible to receive healthcare but opted not to.

Modern Healthcare reports that some hospitals are also considering offering less generous financial assistance for patients who chose not to purchase insurance. Vermont-based Fletcher Allen Health Care, has pursued this option, telling Modern Healthcare that it did not want to make financial aid more attractive than subsidized health insurance. The publication also notes that Vermont has “the highest percentage of uninsured residents in the country with incomes that qualify them for subsidized coverage.”