Are the Healthcare Exchanges Working? - David S. Guzick, UF Health


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David S. Guzick, a speaker at the marcus evans National Healthcare CXO Summit Spring 2014, talks about the healthcare insurance market and the lessons learned.
Interview with: David S. Guzick, President, UF Health

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Are the Healthcare Exchanges Working? - David S. Guzick, UF Health

  1. 1. Interview with: David S. Guzick, President, UF Health “The insurance exchanges are working to a variable degree. We cannot generalize so early in the program, as there is huge variability from state to state, even within states,” says David S. Guzick, President, UF Health. Unfortunately, some hospitals are now worse off, so they must adapt to the new healthcare environment, he adds. Guzick is a speaker at the marcus evans National Healthcare CXO Summit Spring 2014, in Palm Beach, Florida, May 18-20. What are the lessons learned? What do healthcare leaders need to know? We have learned that the availability and degree of access to these insurance products in the private markets, subsidized by the federal government, depends in part on the political framework in the state and how devoted it has been to maximizing access and effective communication. Whether Medicaid expansion was legislatively approved by the state is a big factor, as this seems to correlate with the efforts made to provide access to the exchanges, and convey information about them to those in the 133-400 percent of the Federal Poverty Line, which defines eligibility. The second lesson is related to the number of insurers in the market. In some areas many insurers are competing for business, which tends to drive down the price of premiums, deductibles and co-pays, while other communities have just one insurer providing a plan. How does this impact a hospital’s profitability? It may be good or bad, depending on the situation. I’ll give you an example of “bad”. UF Health includes hospitals in Gainesville and Jacksonville in which eight percent and 17 percent, respectively, of admitted patients are uninsured. This translates to about USD 90 million and USD 80 million of free care at the two hospitals. Had we been in a state with Medicaid expansion, we would have obtained reimbursement for services to our neediest patients that we are now providing for free. Regarding exchanges, the small number of insurers has led to high prices. In Gainesville, for example, just one insurance product is being offered, with a high deductable, so very few are signing up. Some people would rather pay the relatively small tax penalty, as they do not perceive that they can afford the out-of-pocket costs. Of course, for hospitals located in states where Medicaid expansion is occurring and there is greater pick-up on the exchanges, profitability may increase as some payment is received for medical care that had been previously unreimbursed. What is next? I expect things to gradually change across time. The number of insured people will slowly rise from seven million to twenty million or more over the next several years. Some states may reconsider Medicaid expansion and become more active in encouraging uninsured populations to take advantage of the health exchange marketplace. Those of us on the provider side will just have to adapt as things move along. The adaptation is going to be very different in different locations. Kentucky has so many individuals signing up, for example, that many hospitals are concerned about being able to accommodate the volume. We are in the opposite situation, wondering how we can continue to provide medical care to uninsured patients at a time of reduced safety-net funding and virtually no reimbursement from the main provisions of Obamacare. Do you have a final message? For providers in states without Medicaid expansion and poor pick-up of exchanges, bring awareness to your state legislators about the nature of the healthcare environment and how it is being impacted by uninsured individuals and various aspects of the ACA. Work in your local communities during the next open enrollment period to improve enrollment under the insurance exchange program. Above all, try to work as best as you can with an imperfect law to benefit the patients we serve. Those of us on the provider side will just have to adapt as things move along Are the Healthcare Exchanges Working?
  2. 2. About marcus evans Summits marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, case studies, roundtables and one-on-one business meetings. For more information, please visit: Upcoming Events Long-Term Care CXO Summit - National Healthcare CFO Summit - National Healthcare CNO Summit - To view the web version, please click here: The marcus evans Summits groups deliver peer-to-peer information on strategic matters, p r o f e s s i o n a l t r e n d s a n d breakthrough innovations. Please note that the Summit is a closed business event and the number of participants strictly limited. About the National Healthcare CXO Summit Spring 2014 The 10th National Healthcare CXO Summit is the premium forum bringing senior level healthcare executives and solution providers together. Taking place at the Eau Palm Beach Resort & Spa, Palm Beach, Florida, May 18-20, 2014, the Summit includes presentations on healthcare reform, successfully building an ACO, achieving physician integration, service line diversification and improving quality of care. Contact Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division Tel: + 357 22 849 313 Email: For more information please send an email to All rights reserved. The above content may be republished or reproduced. Kindly inform us by sending an email to