In a small office with papers scattered across a desk, I interviewed Rich Felbinger, the Chief Financial Officer of Borgess Health. As a CFO, some of Mr. Felbinger’s duties include making sure financial statements are prepared appropriately and according to the accounting rules, participating in strategic planning for the corporation, and representing the corporation on several joint venture boards, as well as with Borgess’ parent organization: Ascension Health. Borgess serves nearly one million people living in 10 counties in southwest Michigan, and employs close to 300 physicians and physician providers. The patient demographics include: 50% Medicare patients, 20% Blue Cross Blue Shield patients, and 12% Medicaid patients, with the remaining percentage being commercial or self-insured patients.

Mr. Felbinger offered his viewpoint regarding the ACA strictly from a hospital standpoint. First and foremost, he stated that hospitals nationwide would lose over $100 billion of reimbursement over the next ten years. Borgess is specifically receiving $15 million less each year, in comparison to the previous Medicaid program. This alone requires him to downsize his staff, having to layoff over 150 people already, as well as reducing Borgess expenses significantly. Mr. Felbinger stated, “[Borgess] will be reducing workforce to see if they can live under the lower revenue,” and then chuckled as he declared, “That’s why I have so much gray hair.” Borgess is not the only hospital losing money, but since 50% of Borgess’ patients receive Medicare, they really have to focus on making enough money to replenish their assets.

Mr. Felbinger and his colleagues have also noticed that individuals who enrolled can only afford high deductibles or high out-of-pocket plans. Mr. Felbinger stated that “People are coming in who have to have services and they are having to pay a lot more out of their pocket, but they don’t have the assets, so [Borgess] is writing off more.” As a result they are seeing their charity debt rise significantly. Mr. Felbinger touched on the fact that people who want to have elective procedures, such as hernia surgery, are postponing the procedure due to costs until it is absolutely necessary. Furthermore, they noticed the ACA disrupted people who had insurance; “People had insurance that they wanted, but because they didn’t have ‘all the right coverages’ they were dropped and now have high costing insurance plans.”

Mr. Felbinger also noted that the ACA requirement to move to electronic medical records has affected overall productivity and availability of physicians to patients. He explained, “It was reported that if we did this we would save money, but at the moment we are actually spending money with the new software.” He described a 20% drop in their ability of giving care to patients when Borgess started using the automated medical record. However, they were able to make back about half of that, so it amounts only to a 10% reduction in productivity.

Even though the disadvantages of the ACA are very noticeable within the hospital, Mr. Felbinger believes that there are positives associated with the ACA, primarily the Medicaid expansion, which allows more people to qualify for Medicaid. Borgess offers certified enrollment counselors on site and enrolled 60 people within the month of April. However, Mr. Felbinger forecasts that the strain that the hospitals are experiencing will result in some hospitals shutting down. He imagines that a lot of the smaller hospitals in our region will not be able to stay open, resulting in reduction of health care access. With a knock on wood, he stated, “Borgess is lucky they have not experienced that.” Without changes, he predicts a situation where we do not have unlimited health care access nationwide.

In general, Borgess tries to inform people in anyway possible. However, Mr. Felbinger stated, “Unless you need tires for your car you don’t pay attention to the advertisements for tires, only when you need it do you start paying attention. That’s how people view healthcare; they don’t think about it until it is too late, and when they do it turns out to be pretty expensive.”

Mr. Felbinger also believes that our expectations of health need to change; he said, “Right now if you are hurt or get sick you have an emergency room on just about every corner and [hospitals] have all types of specialists waiting around for you to come in and treat you right away. However, we are not going to be able to afford that in the future. In other countries you wait. In fact, we have patients coming here from other countries that are waitlisted.” For example, Borgess had a patient come from Canada, who was on Canada’s critical care list for heart surgery. However, he would have had to wait six months in Canada, but only had to wait one week in the United States for his surgery.

Theoretically he believes that “It is nice that everyone will sign up, but if you’re a younger person you’ll pay to not have insurance rather than pay more a month for insurance coverage. It’s a good thought and good reason to do it, but in reality, instead of 40 million people without insurance, we will have 30 million people without insurance.” He expects that hospitals and others will fight the changes, but at some point they aren’t going to be able to anymore; people and care providers won’t be able to afford it, and there will be changes that have to be made. Mr. Felbinger gave examples such as fewer physicians and people at the bedside, longer wait time, and different insurance or access rationing strategies.

Mr. Felbinger stated he is “generally open-minded to the ACA,” even though he is a conservative. Overall, Mr. Felbinger believes that the ACA is well intentioned but will need some major modifications in the upcoming years. From this interview, both Mr. Felbinger and I decided on the importance of answering a difficult question: “What are we, the hospital, the community, the nation, going to look like in a few months? In a year? Five years? A decade?” The Affordable Care Act may have positive effects for some, perhaps even many, but Borgess Health is a clear example of disadvantageous consequences and suggests the need for changes within the ACA.