Some hospitals are establishing enrollment desks to catch patients on exit from their emergency department episode, during what might be a teachable moment about the importance of having health coverage.
But how much push hospitals should give them, and at what points in their medical journey, remain to be seen.
Lott notes that "it's not in the culture of a hospital to think that it ought to do this kind of outreach for a government program. I'm not saying that's a good thing. I'm just saying that's not normal, unless (hospitals) are asked to do this. You're going to find very few of them motivated to just go do that because it's a good thing to do. It's just not in their thinking."
Cynthia Taueg, vice president of ambulatory and community health services at St. John Providence Health System in Detroit, says "there's a great potential for conflict, that's for sure. And for anti-trust issues. The potential is there."
She adds that at St. John Providence, "We don't pay for anybody's premium now, and it's not anything we're considering. But if the feds make it allowable, then we'll look at it at that time."
Legal minds at CMS will decide. During the hospital webcast Sept. 16, CMS' Cohen said hospitals have a lot of power to influence how patients respond to the new exchanges.
"They trust you," she told webcast listeners. "They trust doctors, pharmacists, nurses. They trust their healthcare providers in their community. "