A Rise in Bad Debt
Another pitfall for NFP hospitals is the "timing mismatch" between the savings that hospitals should expect sometime in the future for treating fewer uninsured patients, and real reimbursement cuts that went into effect on Oct. 1 for Medicare, Medicaid, and Medicaid disproportionate share payments [DSH] for safety net hospitals.
Goldstein said bad debt likely will rise because new enrollees previously insured by a commercial insurer are likely to sign on to plans with high co-pays and deductibles, which they may ultimately be unable to pay. Moody's also expects some delays in payments and processing claims among exchange-based insurers because they will tend to be smaller and less experienced, and will take time to come up to speed.
In addition, private health insurance exchanges that are not part of the Patient Protection and Affordable Care Act are expected to become more popular with private employers looking to reduce healthcare benefits. Goldstein says reimbursements from insurers on private exchanges are expected to be lower than those from commercial insurers.
The nation's largest hospital associations have supported the PPACA, but have also raised concerns about the unintended consequences and potential financial burdens that hospitals could face during the implementation.