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Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
Pandemic or Panacea?  The Financial Impact of the ACA on the Modern Health Care Industry
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Pandemic or Panacea? The Financial Impact of the ACA on the Modern Health Care Industry

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Four years into its evolution, the political debates surrounding the Affordable Care Act continue to engage the nation. From its inception, the impact of the ACA on the changes in health care for …

Four years into its evolution, the political debates surrounding the Affordable Care Act continue to engage the nation. From its inception, the impact of the ACA on the changes in health care for individuals has held center stage. However, what will be the fiscal ramifications for the health care industry as a whole? With a revamped emphasis on efficiency and quality of service on the part of providers, transparency for payers and the notion of patient responsibility, how will the industry fare as it transitions from its cost-based legacy toward a performance-based model? Like it or not, America’s new health care structure is here to stay, and so we must be mindful of the collateral damages faced by the industry as the ACA works through its growing pains, while paying special attention to the burdens placed on smaller systems, hospitals and providers who find themselves ill-prepared to weather such storms. This panel will discuss the impact of the ACA on the financial wellbeing of California’s hospitals and physicians.

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  • 1. PAGE: 1 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA PANDEMIC OR PANACEA? The Financial Impact of the ACA on the Modern Health Care Industry California Society of Healthcare Attorneys Annual Meeting and Spring Seminar DATE: April 13, 2014 TIME: 9:30 AM to 10:30 AM PLACE: Resort at Squaw Creek PRESENTERS: Samuel Maizel, Esq., Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Esq., Garner Health Law Corporation
  • 2. PAGE: 2 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA INTRODUCTION
  • 3. PAGE: 3 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Distressed Hospitals in the U.S.  Distressed hospitals are those operating with an EBITDA of 0% or less annually.  This represents a significant number of America‟s hospitals, as more than one-third of the nation‟s hospitals reported a negative operating profit margin in 2012 (22.4% of California‟s hospitals operated at a loss in 2010).  Even with other resources, the number of hospitals with a negative total margin exceeded one-quarter of all hospitals in America.
  • 4. PAGE: 4 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Distressed Hospitals in the U.S. Continued  California‟s 373 hospitals had an average operating profit margin of 2.63% in 2012.  More than one-third of Massachusetts hospitals lost money in 2011. Overall the state‟s 65 acute care hospitals had only a 2.1% profit margin.  New Jersey‟s hospitals had only a 0.3% profit margin in 2011.
  • 5. PAGE: 5 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  The Affordable Care Act‟s reductions in payment rates to hospitals and other providers have slowed the growth of Medicare spending (compared with projections under prior law).  Reduced payments to hospitals and other providers under Medicare will lessen their income or profits, but those changes are likely to decrease demand by a relatively small amount. Congressional Budget Office (2014-2024)
  • 6. PAGE: 6 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Congressional Budget Office (2014-2024) Continued
  • 7. PAGE: 7 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 72 Federal Register 47130 (Aug. 22, 2007).  CMS adopted a Medicare Severity DRG classification system for the IPPS as a way to better identify severity of illness.  MS-DRGs are also linked to (1) complications or comorbidities (CCs) and (2) major complications or comorbidities (MCCs).  As of 2014 the original 467 DRGs from the 1982 system were expanded to include an IPPS with 1,622 MCCs and 3,529 CCs. MS-DRGs
  • 8. PAGE: 8 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA PERFORMANCE BASED REIMBURSEMENT
  • 9. PAGE: 9 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 78 Federal Register (No. 160) 50496-51040 (Aug. 19, 2013)  Hospital Value-Based Purchasing Program  Physician Value Based Purchasing Program  Hospital Readmissions Reduction Program  Hospital Acquired Conditions  National Quality Forum‟s List of Serious Reportable Events  Medicare Severity Diagnosis Related Groups (MS-DRGs) Performance Based Reimbursement
  • 10. PAGE: 10 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA “[W]e are very concerned that many of the quality measures upon which federal pay-for-performance programs are based do not produce accurate performance results, making them inappropriate to use for public reporting and accountability programs. Moreover, we believe the manner in which some of the payment penalties are calculated lacks fairness and equity.” American Hospital Association on Performance Based Reimbursement
  • 11. PAGE: 11 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 42 U.S.C. § 1395ww(o); 78 Federal Register 50677.  The DRG system now includes value-based purchasing.  CMS will start paying hospitals Medicare “bonuses” based upon overall performance, adherence to quality measures and patient satisfaction.  This epic change is designed to transform a system that has historically been based on cost into one that focuses primarily on quality and performance. Hospital Value-Based Purchasing (VBP) Program
  • 12. PAGE: 12 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Funding for value-based purchasing comes from base operating DRG reductions (1.25% in 2014, 1.5% in 2015, 1.75% in 2016, and 2% thereafter).  Hospitals with poor performance ratings may be excluded from bonus opportunities.  The VBP Program is based on a hospital‟s total performance score (TPS), which includes, in part:  12 Clinical Process of Care measures (70% of TPS)  8 Patient Experience of Care dimensions (30% of TPS) Hospital VBP Program Continued
  • 13. PAGE: 13 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Hospital VBP Program Continued Percentage Reduction and Estimated Total Withholding
  • 14. PAGE: 14 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Hospital VBP Program Continued 2014 Quality Measures In Fiscal Year 2015, Medicare regulations will add two new outcome measures and an efficiency measure. New measures will also be added in Fiscal Year 2016.  Acute MI  Heart Failure  Pneumonia  Surgical Improvement  Patient Experience of Care
  • 15. PAGE: 15 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Hospital VBP Program Continued From the AHA: “[S]ome of the measures selected for use in VBP are deeply flawed, and do not accurately reflect hospital performance.” “We believe CMS should assign a lesser weight to scores from the HCAHPS survey.”
  • 16. PAGE: 16 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA California Hospitals – VBP Year 2 (Nov. 2013)
  • 17. PAGE: 17 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Hospital VBP Program Continued Potential Loss Under the Hospital VBP Program as of 2017 2% Running Total Under the Medicare Program 2%
  • 18. PAGE: 18 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 42 U.S.C. § 1395ww(q); 78 Federal Register 50653.  In Fiscal Year 2013, HRRP could reduce a hospital‟s base operating Medicare DRG payments with respect to readmissions for three conditions:  Acute myocardial infarction (AMI)  Heart failure (HF)  Pneumonia (PN)  The statutory floor adjustment for 2013 was 0.99 (1% reduction), 0.98 for FY 2014 and 0.97 for FY 2015 and subsequent years. Hospital Readmission Reduction Program (HRRP)
  • 19. PAGE: 19 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA HRRP Continued Aggregate payments for excess readmissions = [sum of base operating DRG payments for AMI x (Excess Readmission Ratio for AMI-1] + [sum of base operating DRG payments for HF x (Excess Readmission Ratio for HF-1] + [sum of base operating DRG payments for PN x (Excess Readmission Ratio for PN-1)]. Aggregate payments for all discharges = sum of base operating DRG payments for all discharges. Ratio = 1 – (Aggregate payments for excess readmissions/Aggregate payments for all discharges.)
  • 20. PAGE: 20 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA From the American Hospital Association  “The AHA is concerned about both the readmission measures used in the HRRP, and the manner in which the payment penalty is calculated.”  “The penalty’s inverse relationship between the national readmission rate and the magnitude of penalty also may punish hospitals for making progress in reducing readmissions.”  “The measures also do not distinguish between related and unrelated re-admissions, in spite of the ACA requirement that unrelated readmissions be excluded.”
  • 21. PAGE: 21 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA California Hospitals – HRRP 2014
  • 22. PAGE: 22 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA HRRP: How Much Is At Risk? Potential Loss Under the HRRP as of 2015 3% Running Total Under the Medicare Program 5%
  • 23. PAGE: 23 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 42 U.S.C. § 1395ww(p); 78 Federal Register 50523.  The Deficit Reduction Act of 2005 (DRA) required a quality adjustment in Medicare Severity Diagnosis Related Group (MS-DRG) payments for certain hospital acquired conditions.  Hospitals do not receive the higher payment for cases when one of the selected conditions is acquired during hospitalization.  Medicare reimburses provider as though the secondary diagnosis is not present. Hospital-Acquired Conditions (HAC)
  • 24. PAGE: 24 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Foreign Object Retained After Surgery  Air Embolism  Blood Incompatibility  Pressure Ulcer Stages III & IV  Falls and Trauma  Catheter-Associated UTI  Vascular Catheter-Associated Infection  Surgical Site Infections Hospital-Acquired Conditions Continued
  • 25. PAGE: 25 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  “The AHA has concerns about the selection of quality measures in the ACA-mandated HAC payment reduction program, as well as the fairness of the payment penalty.”  “Using the same measures in more than one pay-for- performance program may subject hospitals to unfair double payment penalties. Moreover, the different constructs of the programs and the disparate ways in which good versus bad performance is identified could send potentially conflicting signals to patients and hospitals.” From the American Hospital Association
  • 26. PAGE: 26 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Hospital-Acquired Conditions Continued
  • 27. PAGE: 27 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA HACs: How Much Is At Risk? Potential Loss Under HAC 1% Running Total Under the Medicare Program 6%
  • 28. PAGE: 28 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA The American Taxpayer Relief Act of 2012 (Pub. L. 112-240)  $1.2 trillion, across-the-board cuts to government agencies over the next 10 years.  Equal divide between defense and domestic discretionary spending.  Hospitals experienced a 2% cut in Medicare reimbursement. Sequestration
  • 29. PAGE: 29 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Sequestration: How Much Is At Risk? Potential Loss Under Sequestration 2% Running Total Under the Medicare Program 8%
  • 30. PAGE: 30 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Pub. L. 99-272 (Apr. 7, 1986), amending 42 U.S.C. § 1395ww(d)(5)  Congress established a measure to assess whether a hospital services a significantly disproportionate number of low income patients.  This “disproportionate patient percentage” (DPP) is the “sole variable in the „disproportionate share adjustment percentage‟ that ultimately determines the dollar amount of any enhanced payment due to a DSH.” Metropolitan Hosp. v. U.S. Dept. of Health and Human Services, 712 F.3d 248, 250 (6th Cir. 2013). Disproportionate Share Adjustments
  • 31. PAGE: 31 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Hospitals in the United States provided $41.1 billion in uncompensated care in 2011, including “bad debt” (services for which a hospital expected to be paid but was not paid) and charity care (services for which a hospital never expected to be paid and was not paid, usually because the patient qualified under the hospital‟s charity care policies).  Americans rely heavily on hospital emergency departments. In 2011 there were over 129 million emergency department visits, and this number has increased 22% in the past decade. Disproportionate Share Reductions Continued
  • 32. PAGE: 32 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Medicare recognized the impact of the financial burden felt by those hospitals treating a disproportionate number, especially those in lower income, urban and rural neighborhoods.  Medicare provided supplemental payments to these hospitals, called Disproportionate Share (“DSH”) payments.  DSH payments total over $20 billion annually. Disproportionate Share Reductions Continued
  • 33. PAGE: 33 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Starting in Fiscal Year 2014, hospitals that usually receive Medicare DSH payments will receive these monies in two separate payments:  (1) 25% of the amount the hospital previously received under Medicare DSH; and  (2) “an additional payment for the DSH hospital‟s proportion of uncompensated care, determined as the product of three factors.” Disproportionate Share Reductions Continued
  • 34. PAGE: 34 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA These three factors, which now make up 75% of the Medicare DSH funds to which a hospital may be entitled, include:  (1) 75% payment of the payments that would otherwise be made [under the old DSH methodology];  (2) 1 minus the percentage change in the percent of individuals under the age of 65 who are uninsured (minus 0.1 percentage point for FY 2014, and minus 0.2 percentage point for FY 2015 through FY 2017); and Disproportionate Share Reductions Continued
  • 35. PAGE: 35 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  (3) a hospital‟s uncompensated care amount relative to the uncompensated care amounts of all DSH hospitals expressed as a percentage. Disproportionate Share Reductions Continued
  • 36. PAGE: 36 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Disproportionate Share Reductions (2014-2020)
  • 37. PAGE: 37 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA THE IMPACT ON HOSPITALS
  • 38. PAGE: 38 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Today‟s epic change in hospital reimbursements is designed to transform a system that has historically been based on cost into one that focuses primarily on quality and performance.
  • 39. PAGE: 39 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  These cuts create a daunting challenge for the many financially distressed hospitals in America that simply lack the resources to establish an infrastructure designed to treat Medicare patients in this era of change.  In 2010 the estimated difference between the hospital industry‟s cost of care to Medicare and Medicaid beneficiaries and their reimbursement was over $27 billion. The Impact on Hospitals
  • 40. PAGE: 40 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  It has been estimated that Medicare profit margins were approximately minus 4.5 percent (-4.5%) for all hospitals in 2010, and will decline to minus 7 percent (-7%) in 2012.  More than half of the urban safety-net hospitals in America lost money in 2009, and generally their operating margin was minus .06 percent (–0.06%).  However, it is estimated that the Affordable Care Act will force an additional 10% of the urban safety-net hospitals to lose money and reduce their median operating margin to minus 2.02 percent (-2.02%). The Impact on Hospitals Continued
  • 41. PAGE: 41 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA  Brooklyn, New York estimates that 20% of its patients are uninsurable.  In some regions of Central California, an estimated 40% of the residents were undocumented, immigrant farm workers.  Hospitals in New York previously received $2.84 billion annually in DSH payments. Under the Affordable Care Act, these DSH payments have begun to decrease in 2014, and by 2019 these payments will be reduced by more than half. The Impact on Hospitals Continued
  • 42. PAGE: 42 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA 7 million uninsured nonelderly Californians Source: Kaiser Family Foundation Uninsured Californians and Access to Coverage
  • 43. PAGE: 43 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Samuel Maizel Pachulski Stang Ziehl & Jones LLP Sam is a partner with Pachulski Stang Ziehl & Jones LLP, the nation‟s largest restructuring and insolvency law firm. Sam‟s practice includes advising and representing businesses on bankruptcy matters and financial restructuring in and out of court, with an emphasis on the healthcare industry. Before joining Pachulski Stang, Sam represented the Federal Government in bankruptcy, district, and appellate courts nationwide as a trial attorney in the US Department of Justice‟s Commercial Litigation Branch. Sam has also served in the US Army‟s Judge Advocate General‟s Corps, including service in Operation Desert Shield/Desert Storm, for which he was awarded the Bronze Star Medal. Sam has lectured extensively, is widely published, and has been interviewed on television and radio on bankruptcy topics. Additional information can be found at www.pszjlaw.com.
  • 44. PAGE: 44 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Craig B. Garner Garner Health Law Corporation Craig is an attorney and health care consultant, specializing in issues pertaining to modern American health care and the ways it should be managed in its current climate of reform. Craig‟s law practice focuses on health care mergers and acquisitions, regulatory compliance and counseling for providers. Craig is also an adjunct professor of law at Pepperdine University School of Law, where he teaches courses on Hospital Law and the Affordable Care Act. Between 2002 and 2011, Craig was the Chief Executive Officer of Coast Plaza Hospital in Norwalk, California. Craig is also a Fellow Designate with the American College of Healthcare Executives, a Member of the State Bar of California, Business Law Section, Health Law Committee and a Vice Chair of the Healthcare Reform Educational Task Force of the American Health Lawyers Association. Additional information can be found at www.garnerhealth.com.
  • 45. PAGE: 45 Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Pandemic or Panacea? The Financial Impact of the ACA Samuel Maizel, Pachulski Stang Ziehl & Jones LLP Craig B. Garner, Garner Health Law Corporation Thank You

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