Hospital administrators in the state said they largely support the federal health care reform legislation upheld by the Supreme Court last month, but many are apprehensive about major pieces of the law, including the possible expansion of the state's Medicaid program.
Though the Patient Protection and Affordable Care Act was passed more than two years ago, the Supreme Court's decision removed a lot of the uncertainty surrounding the legislation that aims to provide health insurance for roughly 32 million more Americans by 2014.
Locally, hospital executives said they've been preparing for the onset of the reforms, mainly through administrative changes, such as moving to electronic medical records expected to streamline the health care process.
But most added that there are significant unanswered questions about how health care reform will affect their business and the patients they serve.
The Medicaid question
One major concern is the effect potential expansion of the state's Medicaid program could have on the state's hospitals. The Supreme Court decision gives states the option of whether to extend Medicaid benefits to all non-Medicare individuals under 65 with incomes up to 133 percent of the federal poverty level.
Currently, there are about 575,000 Connecticut residents for whom Medicaid is their primary insurance, and a large portion of the care provided to these patients isn't reimbursed, Frayne said. In 2010 alone, he said, hospitals spent $400 million more caring for Medicaid patients than they received in reimbursement. If the Medicaid program expands, he said, there could be 700,000 state residents primarily insured through Medicaid by 2014.
Though states will receive federal funding for the expansion, Frayne said it's unclear where that money will go.
If the funds go to help reimburse those caring for Medicaid patients, that will somewhat ease the burden on providers. But, Frayne said, "If the program expands to 700,000 and none of the new funds go to reimburse providers, Medicaid losses are forecasted for hospitals in excess of $750 million a year."
Not enough doctors
Another major issue is how the expected influx of newly insured patients in 2014 will affect the ongoing physician shortage.
"When 32 million people come on to the health care rolls, do we have enough doctors to take care of them?" asked Ron Bianchi, corporate senior vice president at St. Vincent's Medical Center in Bridgeport. "We want a health care system that leaves no one behind, but how do we rise to that challenge?"
In 2010, there was already a shortage of 13,700 physicians nationwide, according to the Association of American Medical Colleges, a nonprofit representing faculty members, medical students, and resident physicians at medical schools, teaching hospitals and other institutions. The association predicts that the shortage will grow to 62,900 doctors by 2015 and to 91,500 by 2020.
Bridgeport Hospital President and Chief Executive Officer William Jennings agreed with Bianchi that the reforms could leave the health system more congested than ever. "Just because you have insurance doesn't necessarily mean you're going to be able to get a doctor's appointment," he said.
Some possible benefits
On the positive end, the legislation could mean a drop in the amount of unpaid care hospitals provide. Many hospitals in the region end up providing a significant amount of "free" care to uninsured patients.
For instance, Griffin Hospital in Derby provided almost $11 million in services to "patients who were unwilling or unable to pay" in fiscal year 2011, according to its most recent financial reports.
"When patients come into the hospital who are uninsured, typically they don't pay and the hospital incurs bad debt," said Patrick Charmel, president and chief executive officer of Griffin Hospital.
Under health care reform, many of those "free" patients would have access to insurance.
Griffin is far from the only hospital providing uncompensated care.
Bridgeport Hospital, for example provided $16.5 million of "free" or charity care in fiscal year 2011. Like Charmel, Jennings said that when the most significant provisions of the health care act go into effect many of the people who now receive free care will be covered by insurance, which could benefit hospitals like his.
But even with the Supreme Court decision removing a lot of the ambiguity around health care reform, many hospital administrators are still unsure of what the ultimate impact will be on their facilities. Some, like Corvino, aren't even confident that the reforms are here to stay.
"The big test is how the election turns out six months from now," he said. "If the president doesn't get re-elected, the Affordable Care Act as it exists now might not even be around any more."
email@example.com; 203-330-6290; http://twitter.com/AmandaCuda; http://blog.ctnews.com/whatthehealth/