At Chicago's Mt Sinai Medical Center, a big part of the core mission is that you don't turn patients away whatever their insurance status. And when 13 percent of your patient population is uninsured, that makes for a big financial burden."Caring for a large number of uninsured and struggling with our ability to do that. Now to get paid, albeit below cost, but to get something back to be able to pay for those folks is really important," said Alan Channing, president and CEO, Sinai Health System.
So the health care reform legislation is welcomed there, but there are significant long term questions about how you change the long held practice of patients heading to the emergency room for their primary care, especially in a neighborhood where the number of uninsured is twice the statewide average.
"We've passed insurance reform of some kind, but it is unclear what kind of health reform we will have," said Dr. David Nash, Jefferson Medical College.
Some of the health care executives meeting in Chicago say they are concerned with the size and complexity of the health care reform legislation, and how ultimately it leads to wiser, more cost efficient hospital practice and better, less expensive patient care when Medicaid and Medicare re-imbursements to hospitals will be lowered.
"How are we going to take cost out of the system. Hospitals have to contribute. We aren't as efficient as we should be, and we have to get better," said Chris Van Gorder, Scripps Health Systems.
From a practical standpoint, that means more efficient electronic record keeping, and a reducing the duplication of costly medical testing.
"At least this is a start. I don't think that there is anybody on the House or Senate side or the president that believes that this is the end all," said Van Gorder.
For consumers, the legislation means health insurance can't be denied for pre-existing conditions, and the number of what are called 'recisions,' that is patients who have their medical insurance ended after treatment, will be significantly reduced.
"Illinois is the national leader, unfortunately, when it comes to recisions. We have more recisions by a large margin than any other state in the country. This bill will limit significantly the possibility of rescissions," said Michael McRaith, director, Illinois Dept. of Insurance.
The Illinois Department of Insurance has posted a "Top 10" list on its Web site of changes that health care reform.
As some of the health care execs meeting in Chicago said Monday, it's hard to predict now how all the changes will play out because the legislation has so many moving parts.