"It's easy to say right now, 'no, no, no, Obamacare is an abomination and Medicaid is dysfunctional,'" John Holahan, the director of the health policy center at the nonpartisan Urban Institute, told CBS News. "Long-term, it's an awful lot of money to give up and the hospitals need it and the managed health care plans need it… I think eventually they will figure out a way to say yes."
That may be true. But how much comfort can hospital executives in Texas and in her like-minded sister states take from assurances that their governors will "eventually" fold on the issue? How can anyone draw up a budget or offer with confidence projections for financial performance amid so much uncertainty?
At the same time that the PPACA provides a set of great challenges for hospitals, they are also struggling with other mandates such as the cost and complications associated with implementing meaningful use of electronic medical records and switching to ICD-10 diagnostic and procedural codes.
Ultimately, hospital leaders in the next decade will face some of the greatest challenges in U.S. healthcare history as they attempt to implement the sweeping reforms of PPACA and other mandates while maintaining financial viability in an era of lower reimbursements.
Outside of a war zone it is hard to imagine a more fluid, uncertain, yet rigorous set of metrics and demands that have to be met.