You’ve read everything you can about the legislative environment (both regionally and nationally)… 1 answer below »
You’ve read everything you can about the legislative environment (both regionally and nationally) and spoken to several brokers who together advise most of the local employers in the region. You believe the most important changes that are about to hit this region are the following: 1. As Medicare reduces DSH and other payments, reimbursement from Medicare will drop from 30% of charges to 28% next year 2. The health exchanges established in the ACA have not been much of a factor in the region so far, but that’s about to change. The two largest payers in your state both plan to really step up in the exchanges and market these plans aggressively both to currently un-insured and those with current, but unattractive employer-based coverage. They believe that by 2021, they’ll have 25% of all commercially insured patients in exchange-based products. 3. There has been a change in both governor and the makeup of the state legislature, which means your state will engage in Medicaid expansion next year. Thus, more people will have coverage, and the uninsured population will diminish, but not go away entirely. Your best estimate is that uninsured visits community-wide will reduce from 70,500 to 6,300. You estimate that, of the patients who have new coverage, half will be Medicaid recipients and half will enter the commercial plans.