How All-Pervasive ACA Uncertainty Worries a Healthcare CFO

For a bird’s-eye view of the current healthcare climate and a forecast of what’s ahead, we spoke with Joanne Aquilina, CFO at Bethesda Health in South Florida. Ms. Aquilina’s point of view has been honed through more than 20 years in hospital financial management and over 10 years of public accounting. Covering a wide range of topics, she focused on several key factors affecting healthcare today and tomorrow. 

Staying Prepared in the Face of the ACA’s Cloudy Future

While little in healthcare is a certainty, the new administration’s effort to repeal and replace the Affordable Care Act has created a firestorm of partisan infighting in Washington. Ms. Aquilina believes resolving concerns about the government’s healthcare policy is the number one challenge for hospital CFOs and CEOs, adding “Whenever we have an unknown of this magnitude that will have a huge impact on our bottom line and ability to budget revenue, it’s indicative of an ominous future.” She describes herself as being in the waiting and watching mode, adding that “something will definitely change, whether the government scraps the entire program or modifies what we have.”

The Complications of Not Expanding Medicaid

She notes Florida’s hospital leaders “are a bit on edge facing the unknown of the new state budget and Medicaid reimbursement rates.” Governor Rick Scott remains opposed to Florida becoming an expansion state, believing the state can manage Medicaid more effectively than the federal government. In a recent CNN commentary, Governor Scott asserted: “If Florida is given the flexibility to run our own Medicaid program, we will be more efficient and less wasteful than the federal government.” Given this view, hospitals in Florida and the other eighteen states opting out of expansion will continue to operate in an uncertain environment.

When Federal Exchange Participation is Limited

Further complicating the situation is the decision of one of Florida’s largest insurers to pull out of the federal exchange. Ms. Aquilina explains that “Humana is a big provider in our market, but they’re pulling out in 2018,” meaning the significant population of Humana covered lives in Florida will be left wondering what will happen to them on January 1, 2018. Two big players remain in the Florida market: Blue Cross Blue Shield and Molina, a managed plan for Medicaid patients. “At least our community still has options, unlike some areas of the country. For example, Tennessee has a huge issue because, Humana—the only remaining exchange plan in that state—is exiting there, too. Tennessee exchange participants may not have any coverage in January,” she adds.

As a hospital CFO, she must also address the problem of patients presenting in Bethesda ERs who fall between Medicaid eligibility and an exchange or private insurance policy. She notes that her health system provides services to those patients on an emergency basis with no realistic expectation of payment.

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April 1, 2021