Executives for public hospitals and rural healthcare providers are looking to 2012 with concerns about the economy, potential funding cuts from Medicare and Medicaid as well as the future of healthcare reform.

Public hospital executives are largely focused on two matters: the economy and the upcoming ruling by the U.S. Supreme Court on the Patient Protection and Affordable Care Act, says Dr. Bruce Siegel, president and CEO of the National Association of Public Hospitals and Health Systems, Washington.

The weakness in the economy has led to high unemployment, which drives more people into the healthcare safety net hospitals as uninsured patients or as part of the Medicaid program, Siegel says. He says there are glimmers of stabilization of the economy in some of states, and there seems to be less urgency to cut Medicaid at the state level. Looking to 2012, “if the economy seems to be healing, then the pressure will start to come down,” he says. “If it tanks, it will be ugly.”

Siegel also says whether the Supreme Court responds to the challenges to the ACA in a whole or piecemeal fashion also will be of importance to safety net providers and healthcare in general. Clarity would be provided if it either strikes it down or affirms it completely, but if the high court strikes down only part of the law, providers and the rest of the industry will suffer. “The Supreme Court will either help us get certainty in healthcare or make things far worse,” he says.

Rural healthcare providers are in a similar situation, with worries about the economy and the possibility of reductions in federal reimbursement. The lagging economy is hitting rural providers while the benefits from the ACA have yet to kick in for the most part, says Alan Morgan, CEO of the National Rural Health Association, Washington.

Rural providers were tagged by some on Capitol Hill as a possible place to cut Medicare to help balance the budget in 2011, and a number of special Medicare programs are going to need to be extended by Congress in 2012.

“There's an extreme amount of angst out there” that special rural health programs will be cut, Morgan says. Rural providers are operating with limited resources as is, and the lament is, “We've already cut what we can cut,” he says.