On Tuesday, the Obama administration said it would delay a key provision of the Affordable Care Act requiring businesses to provide health insurance for workers or pay a penalty. But the Obamacare health insurance exchanges are still very much on track to open October 1. With less than 100 days to go, hospitals across the country are scurrying to prepare.
Some medical centers are worried about the sheer volume of new patients, while others say too much remains unknown to identify where problems might lie.
"We are still waiting for a tremendous amount of information about how this is actually going to work," says Steven Glass, the chief financial officer of the Cleveland Clinic, a massive private medical center located in Cleveland, Ohio. "I think that means we are in the same boat everyone else is in."
The Obama administration had been slowly releasing information about the government-run online health insurance marketplaces, which will allow people to buy insurance plans from private health care providers online. But last month, NPR reported the administration had begun a massive PR push to get the 30 million eligible Americans more aware of how the marketplace will work. Part of that push: Health and Human Services asked the NFL and other sports leagues to help promote the new health care options.
Despite the hype, officials at the nation's medical centers say the conversation hasn't provided much detail.
"I think at this point the most uncertainty is about what products will be offered through the exchanges," says Glass. "For providers that will translate into changes on who comes to your facility vs. another one."
And so medical centers like the Cleveland Clinic are preparing for the worst - or best, depending on how you look at it: a giant influx in patients. Anticipating the largest increase in primary care patients, the clinic has gone from roughly 15 to 29 primary care practices over the last year and a half alone. They've also added dozens more staff.
The University of Chicago Medicine Campus, meanwhile, just opened a 10-story, 1.2 million-square-foot adult hospital, the Center for Care and Discovery, which will deal with increased demand and handle a variety of medical needs. "It's giving us some new capacity, and part of the general plan for demand that we see generally for a full range of services that will be called upon - including primary care," says Ben Gibson, vice president, government affairs at the University of Chicago. "Because when people don't see a doctor regularly, chronic conditions tend to worsen."
People who have not had insurance for years, for example.
At Medstar Georgetown University Hospital, a medical center affiliated with Georgetown University School of Medicine, spokeswoman Jean Hitchcock says she doesn't expect a huge influx of patients, in large part because Washington D.C. provides good Medicaid coverage.
"But the issue we will have is access, a shortage of physicians," she says. "So we've worked really hard in the last year on improving access to care... so that no matter what comes down the pike, we're ready for it."
Improving access, she says, meant increasing call centers, moving to online appointments, and using more nurse practitioners -- all which they hope will help patients more easily connect with doctors.
Another concern: how to collect the new out-of-pocket payments from patients using the exchanges.
Within the exchanges, insurers must offer at least a gold and a silver plan, though bronze and platinum may also be available. In a bronze plan, the insurer covers 60 percent of health care costs, while the individual pays 40 percent out-of-pocket. In a silver plan, the breakdown is 70-30. Gold and platinum plans have lower deductibles, but may come with higher monthly fees.
"It's an increase in patients with financial responsibility. And how to pursue collecting those dollars is much more burdensome than going through [employer] health care," says the Cleveland Clinic's Glass.
Medstar Georgetown's Hitchcock says revenue flow is going to be something every health care provider is focused on -- especially because people will have the ability to change health care plans quickly through the exchanges.
"You know when your doctor asks 'has anything changed?'" she says. Patients may be hearing that question a whole lot more come October 1.