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Providers May Be Hit by Health Insurance Exchanges

Rene Letourneau, for HealthLeaders Media, July 1, 2013

Healthcare CFOs from very different organizations express concern that HIX, both state- and federally operated, will have negative financial repercussions.

There are different pieces to the uncertainty around health insurance exchanges. One is timeliness: The U.S. Government Accountability Office recently released two reports that cast doubt on whether the HIX established under the Patient Protection and Affordable Care Act will be up and running in time for the Oct. 1, 2013, enrollment period.

But perhaps the bigger uncertainty surrounding the exchanges—both state- and federally operated—is whether they will benefit hospitals and health systems financially. With more people having coverage through the insurance they can purchase from the exchanges, it would appear on the surface that the new marketplace will be good for providers. Yet I've spoken recently with two CFOs from very different healthcare providers who are unconvinced that the exchanges will be a net positive for their organizations, regardless of the exact date of implementation.

Mark Bogen, senior vice president and CFO at South Nassau Communities Hospital, a 435-bed not-for-profit teaching hospital in Oceanside, NY, expects the New York state–run exchange to be online by Oct. 1, with lots of participation from payers and providers because of the political support the program is receiving from the governor's office.

"Gov. Andrew Cuomo is putting pressure on payers to participate in one way or another, whether in individual exchanges or through the small employer component," Bogen says. "He is also looking for broad-based participation from providers and will use the weight of his office if the provider network isn't sufficient."

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1 comments on "Providers May Be Hit by Health Insurance Exchanges"


Dave Sherman (7/11/2013 at 1:32 PM)
These are two very important aspects of the HIX.....one that is overlooked is what happens when the individual who has purchased their coverage through the HIX fails to pay the premiums? Providers will be told that the patient has valid insurance and will provide service but the ACA says that the insurer doesn't have to pay anything for services after 30 days of non payment.....and the provider is stuck trying to collect as self pay. More bad debts!