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"We've analyzed this situation in so many ways because there are so many unknowns," he says. "The best-case scenario is someone who is currently uninsured who we are providing care to, and they end up getting insured. In that case, we have all the cost already and now we are going to just get pure revenue."
A lot depends on which plan consumers select—something that will likely be based largely on their income levels and their eligibility for government premium subsidies, McGuire notes.
"We are not sure how many people are going to select which plan.…If everyone picks the bronze plan, then that could be very negative. We've analyzed this in a lot of different ways, and no one really knows for sure what the actual experience will be until we start getting data."
While McGuire is preparing for the possibility of a net negative to revenue, he also sees a possible silver lining amidst all the ambiguity.
"Businesses have pushed a lot of cost to associates by moving to high-deductible plans, and a lot of that ends up being bad debt. The exchanges may make healthcare more affordable, and people may be able to buy a plan that provides better coverage. That is definitely one of those things we've modeled in a lot of different ways," he says.
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