1. For clarity’s sake let’s remember what the PPACA replaces: A system that left nearly 50 million people without health insurance. Spending completely out of control, threatening our treasury, our economic competitiveness and the long-term future of Medicare. A stunning lack of care coordination. Medical errors killing perhaps 400,000 people each year. A dearth of quality and outcomes measures. Little innovation in care delivery models.
2. Eventually the snafus over the exchanges will be sorted out, and more than 20 million people who were formerly without healthcare insurance will be insured. That’s good, and needed. But it seems clear that many of the plans will be fairly restrictive, and people won’t have as much choice of provider. Out-of-pocket spending will surely increase. At the same time, funding for disproportionate care is being slashed. Safety-net hospitals fear the outcome. This is the $64 billion question: Will the newly insured make up enough of the losses from reimbursement cuts to allow hospitals on tight margins to survive?
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