Although Bogen believes the exchanges will launch on schedule, he is skeptical about what they will mean financially to his hospital on Long Island.
"As opposed to New York City, where they tend to believe most people who sign up for exchanges will be those that are currently showing up in their EDs and entering the system as uninsured, here on Long Island the concern is we may see more of a conversion from employer-sponsored plans, and we'll have to chase after a much larger proportion of the amount [we are owed]," he says.
Bogen fears that small business owners will stop offering health plans, opting instead to accept the fines levied by the government and send employees to the exchanges, where the plans may not be as generous with co-pays and deductibles.
"Our biggest concern on Long Island is that the penalties under the ACA in terms of providing coverage are not really sufficient. … [Employers] may take the penalties and give the dollars to their employees to go out and shop on their own accord through the exchanges. … We're concerned that instead of it being better for providers on Long Island, we'll be hurt by patients who have traditionally been covered through employer-sponsored plans and now have coverage through the exchanges."
Another significant concern for Bogen is that the exchanges are unlikely to reduce the amount of uncompensated care his organization provides to the local population of undocumented workers.