Forbes - "The Bottom Line on ObamaCare: A Plus for Patients and Insurers, a Minus for Hospitals"

 – January 23, 2014  –– 

In my search for clarity with respect to the controversial Affordable Care Act, I was most fortunate in making the acquaintance of Kenneth Davis, MD, the brilliant and refreshingly analytical CEO and President of the Mount Sinai Health System. In fact, five minutes into the interview I experienced an incredible “a-ha” moment when Dr. Davis informed me of the nine matrixes that make up the gist, the guts, of ObamaCare. Dr. Davis’ keen insight allowed me to visualize a cross section of three elements of health care–Access, Cost and Quality–against three principal groups involved in healthcare: patients, providers (hospitals) and payers (insurance companies).   In its utterly simplified terms, Access is beneficial to patients, more or less so for the insurance companies, as they get new clients and unfortunately, and a minus for the providing hospitals and their medical staff. Hospitals will see more patients, but major cuts in DSH programs that cover uncompensated care will hurt. The element of Cost is most definitely a plus for the insurers who get business from the potentially 30 million uninsured Americans who will now have access to health insurance, but it is a minus for the providing hospitals due to restrictions written in to the law. For patients, it can be either a plus or a minus, depending on how many “invincible” young people with no health insurance sign up. Quality is another tricky matter. It should be a plus for patients because the new mandate requires specific quality measures and forces hospitals to provide better care or else lose reimbursement for the risks of numerous re-admissions and hospital born infections. The health insurers get a huge win due to the increase in the number of patients paying premiums. Also, they don’t have to pay for re-admissions, which is a huge benefit when so many poor sick people keep obtaining their medical care through hospital emergency rooms. Providing hospitals should be big winners but they have to meet extremely high quality standards and are not being reimbursed for these additional resource efforts. So, for the provider, what seems to be a plus may actually turn out to be a minus. Learn more