Hospital Executives Reveal Strong Optimism for Success of Obamacare

A survey given to chief executives of major hospitals and health care systems in the US reveals a sense of optimism about President Barack Obama's Affordable Care Act (ACA) that is much greater than that held by politicians and the general public.

Ever since the the US Supreme Court upheld the constitutionality of the ACA, levels of pessimistic and negative sentiment among the public and politicians have been high, with more than half of Americans believing the ACA will have a negative impact on the US health care system. Politicians and pundits argue that the law will raise health care costs and lower quality.

But a team of medical professionals from the University of Pennsylvania who surveyed the nation's leading health care executives reports that the viewpoints of politicians, pundits and the public are not made from a position where they have the necessary information to make such determinations, reporting that among the health care executives surveyed, nearly two-thirds (65 percent) believe that by 2020 the ACA will lead to a health care system that is somewhat to significantly better than it is today.

The UPenn team surveyed 74 executives from health care institutions that had average annual revenues of $1.5 billion and an average workforce of more than 8,500 people, finding a general sense of optimism about the ACA that is not necessarily reflected in by the American public.

The full results of the survey are published on the Health Affairs Blog by Ralph W. Muller, CEO of the University of Pennsylvania Health System, Ezekiel J. Emanuel, MD, PhD, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, Andrew Steinmetz, research assistant to Dr. Emanuel, and Steven M. Altschuler, MD, president and CEO of The Children's Hospital of Philadelphia.

Public pessimism regarding the ACA is pervasive, the study authors write, but it "is hardly a credible predictor of the success or failure of the ACA. Politicians, pundits, and the public are largely removed from the inner workings of the health care system, so it is difficult for them to form an accurate, 360-degree view of reform." The authors also note that 70 percent of Americans admit to knowing little about the ACA or its potential impact.

Among the health care executives responding to the survey, only 3 percent thought that the US health care system in general would be "significantly worse" by 2020. Nineteen percent felt it would be "somewhat worse," 14 percent said it would be about the same as it is now, 50 percent said it would be "somewhat better" and 15 percent said it would be "significantly better."

When asked about how the ACA would affect their own operations, the health care executives were even more optimistic. Ninety-one percent of those surveyed forecasted improvements within their own hospital or health system by 2020. Eighty-five percent expected their organization to have reduced its per-patient operating cost by the end of the decade, with an overall average operating cost reduction expected to be nearly 12 percent.

"It is easy to be pessimistic about reforming the health care system," the authors write. "Change causes uncertainty and therefore anxiety - and anxiety makes people pessimistic. For the leaders of America's flagship hospitals, it would be particularly easy to adopt a pessimistic outlook. Funding for their research missions has been declining. Support for their teaching mission is under threat. Payments for patient care are facing downward pressure, forcing them to transform their business models. Yet hospital leaders appear to be very optimistic about the future of the system."

Among those respondents who expressed pessimistic views of the ACA, they all cited administrative complexity as the greatest barrier to reducing their operations' operating cost.