In addition, PPACA imposes new payment models that include lower reimbursements for hospitals with high readmissions and low patient satisfaction scores, and the effect of those is still unknown.
A study in the Archives of Internal Medicine estimates that safety net hospitals will take an additional hit on reimbursements because Medicaid patients tend to distrust the healthcare system and that distrust is reflected in their lower patient satisfaction scores.
Private payers will follow the government's lead and suffer less tolerance for cost-shifting, preventable errors and other quality issues.
As a result, Moody's deemed "credit neutral" the U.S. Supreme Court's ruling in June that PPACA is constitutional. The rating agency said the high court's decision would have no effect on a negative outlook for the not-for-profit hospital sector.