Now that the long-awaited Supreme Court decision upholding the Affordable Care Act tax subsidies is past, experts are predicting closer scrutiny of the law and its impacts on healthcare providers.
The real question, they said: Just what is healthcare reform going to cost to providers, employers and consumers?
"This King v. Burwell case was kind of like a wildcard as a threat to the law, and it obviously got all of the attention over the past nine months," said Don Susswein, former tax counsel to the Senate Finance Committee, now a principal in McGladrey's in Washington, D.C. "Some of that has prevented people from looking closely at the issues that are clearly left with the bill."
[Also: Supreme court upholds Obamacare subsidies, votes 6-3 in King v. Burwell]
Paul Keckley with Navigant Consulting said he's sure executives felt relief the day after the Supreme Court's June decision.
"If I'm sitting in the CFO's chair, I'm feeling like I dodged a bit of a bullet; my bad debt didn't go up overnight. Now I've got to figure out, what am I going to do about Medicare reimbursement? It's nowhere near what it costs me to operate."
A goal of the Affordable Care Act was to get more people insured, which would decrease a hospital's bad debt. More are insured, but many have high deductibles and are using more services.
"Hospitals are the only sector in healthcare where the law dictates you have to treat someone whether have ability to pay or not," said Keckley.
[Also: King v. Burwell ruling removes uncertainly for individual insurers]
Now that Medicare is clamping down on reimbursement, more insurers and large employers are demanding steeper discounts, and the provider takes on much of the risk, Keckley said.
"The CFOs world is ground zero for reality. All King v. Burwell did was take one little piece and resolve it."
So far, the ACA has done little to ease the spiraling costs of healthcare, now estimated at 6 percent a year, said Keckley.
Susswein said there's a fear there will be added pressure to increase direct federal subsidies for additional exchange customers, possibly creating a new kind of entitlement program.
The political debate of the ACA, including the employer mandate, is nowhere close to a resolution, though, he said. Especially with a presidential election nearing.
Twitter: @SusanMorseHFN