We are one month into the official roll out of the Affordable Care Act (ACA).  It is quickly becoming clear that the ACA has explicit policies, and the Obama Administration has unspoken intentions that will produce unforeseen consequences for our healthcare system and could have broad societal implications.

Just last week we were alerted to widespread health insurance policy cancellations despite repeated assurances by President Obama that we "could keep our health plans if we liked our health plan 'period'."  We now know that there was an explicit policy to eliminate a broad number of individual health policies, three million so far and projected to be as many as 15 million.  The likelihood of these cancellations was known as early as 2009. Regardless, throughout the President's second term candidacy the ACA was sold on the basis that if you liked your plan you could keep your plan.

Consider this development a bellwether for more to come.  Another arena of likely impact is critical access hospitals (CAH's), those under 25 beds and located in rural areas.  The Department of Health and Human Services has decided to reassess the status of these hospitals with a plan to decertify many of our CAH's for failing to fulfill certain national location requirements (i.e., they must be 35 miles from the next hospital).  Nearly 75% of these hospitals, including many in Pennsylvania, could be affected, losing their enhanced Medicare payments and becoming economically unviable.

There is no explicit policy within the ACA to diminish the number of CAH's.  It would have been politically impossible. Republican and Democratic representatives from rural areas would have been outraged.  Nonetheless, the Administration has decided that its view is that these hospitals are not economic and that their reduction or elimination would be beneficial.

Often these CAH's are among the largest employers in their towns.  Therefore, an unintended consequence of downsizing or closing CAH's will be considerable harm to local economies, the loss of well-paying jobs and the reduction of access to healthcare.  The absence of hospitals in an area may discourage new residents and businesses from locating there and drive many to leave in search of a job.

These are but two examples of the intended policies of Obamacare and the intentions of this Administration which have not been understood.  I expect that there will be many more unknown but intended consequences of the ACA with similar unfavorable results.

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