"When I look at Long Island, there may be a small uptick in enrollment, but that isn't going to be enough to be really meaningful as it relates to the uninsured. We do have some farms on Long Island, as well as hotels, resorts, and restaurants where a significant number of the illegal alien population tends to work, so there is still a significant amount of [that] population that will not be covered in all likelihood under the Affordable Care Act."
Two time zones and 2,000 miles away in Albuquerque, NM, at Lovelace Health System, a 606-bed system owned by for-profit Ardent Health Services, CFO Stephen Forney views the small penalties for consumers who decide not to purchase health insurance as a problem.
"The penalties that are sitting out there for not getting your insurance really aren't penalties in the truest sense of the word. They are penalties on paper. The IRS, which is where the penalties would be levied, has no authority to enforce [them]," he says. "Also, the fines are very low to begin with … so the question will be how rapidly people will adopt the exchange products."
Forney expects that patients who have insurance through the exchanges may not fully understand their level of liability for services, which could result in bad debt for the health system. He believes this will be especially true for consumers who are being moved off of other government-subsidized insurance programs to the exchanges.