"The whole plan hinges on the expectation that you would get the young folks to buy insurance and that you would take those premiums that they would pay to help subsidize the entire health system. But, in many cases, they don't see themselves as needing health insurance, are not paying into it, and generally not using it... I just think that it more than remains to be seen if it will work. The individuals may decide they would rather take the penalty than buy the insurance even at what may be considered a cheaper premium," Bogen says.
Bogen also believes that well-managed provider organizations may still experience financial losses due to healthcare reform by virtue of their geography and other factors that are beyond their control.
"For example, on Long Island most of the job creation is really by small employers and the ones that have truly been, whether intentionally or not, targeted by penalties that will start in a year. Historically, it has been the employer-sponsored plans that have covered the majority of us [on Long Island]."
Bogen says because small business owners may opt to take the penalty rather than offer insurance coverage to employees, and that most consumers who buy an insurance product through New York's health insurance exchange will choose the plans with high deductibles and co-pays, health reform may not be a net positive for hospitals and health systems.