After five years of political warfare over the reform law and intensive preparation by the healthcare industry, millions of Americans will get health insurance either through private plans or expanded Medicaid programs in 2014. Insurers will be watching closely to see whether a substantial number of younger and healthier people sign up for coverage, enabling them to keep premiums down in 2015.
But how many uninsured Americans will actually gain coverage, and whether the reform law will help keep healthcare spending growth down, are two of the many uncertainties in the year ahead. The law encouraged the establishment of Medicare and private-sector accountable care organizations—in which hospitals and physician groups share financial rewards and risks for managing patient populations. Providers, payers and economists will be watching to see whether these ACOs deliver on their promise of improving quality and reducing costs.
It's uncertain whether hospitals will continue to see stagnation in the volume of patients in 2014, forcing them to find other ways to increase revenue and maintain operating margins. But they hope the expansion of coverage under Obamacare will encourage newly insured Americans to seek out needed elective care. They also hope the coverage expansion will reduce levels of uncompensated care, though the degree will vary depending on whether a hospital is in a state that chose to expand Medicaid to adults earning up to 138% of the federal poverty level.