He began his presentation by posing a rhetorical question to theaudience seated around him – is change good or bad?

When it comes to national health care reform, King’s DaughtersMedical Center Chief Executive Officer Alvin Hoover sees change asgood and bad. Thursday morning, he reviewed the sweeping changesmandated by the Patient Protection and Affordable Care Act withmembers of the Brookhaven-Lincoln County Chamber of Commerce,singling out some positive changes that would help the Brookhavenhospital while casting doubt on a few other reforms that don’t seemto be quite as well planned.

“A lot of the changes I see in health care I don’t care for, butsome changed was needed,” Hoover said.

Each reform Hoover broke down with the local business communityincluded its own positive and negative consequences. From thestandpoint of the hospital industry, the new health care lawsmandate that 32 million uninsured Americans must have insurance by2019 will mean a decrease in the amount of bad debt hospitals incureach year.

“The uninsured cause a lot of trouble for me at the hospitalbecause I don’t get paid for it,” Hoover said. “Used to, I’d getpaid about $1 for every $10, but now it’s more like 50 cents forevery $10.”

The law also famously provides for the fining of people whodon’t buy insurance after the deadline. Hoover said the proposedannual fines, enacted in 2014, would include $95 per person, $285per household or 1 percent of a household’s taxable income,whichever is greater. By 2016, those fines will increase to $695per person, $2,085 per household or 2.5 percent of a household’staxable income.

“Most of the people who don’t have insurance can’t pay for it,and now you’re going to require them to pay a fine? That’s going tobe hard to enforce,” Hoover said. “I’m excited to see how they’regoing to collect those fines. If they can’t collect, where are theygoing to get the money? They’re going to cut payments toproviders.”

The health care law’s expansion of Medicaid seems like a goodthing for Mississippi hospitals, as the state gets the highestfederal matching rate in the union. But who’s going to pay for thealready-massive program’s expansion?

“Taxes are going up, count on it,” Hoover said.

The law’s payment bundling scheme also seems built with thefinest materials, but by misguided carpenters. The plan calls forpatients who see multiple providers – as when a patient is sentfrom the doctor to the hospital and on to a specialty care provider- to be allowed to pay one cumulative bill that will be broken downand distributed among the providers, like consolidating a loan.

“You want to see a cat fight? Talk about hospitals andphysicians and nursing homes trying to decide how much money eachone gets,” Hoover said. “That’s a scary piece of the business. Idon’t have the money to do it now, and they’re not going to pay meto create that organization.”

Hoover acknowledged the nation may be on the verge of apolitical shift this November, pointing out guarded hopes byRepublicans to repeal the health care laws. There probably will beattempts to repeal and change certain provisions of the law, butthe reforms collectively known as Obamacare are here to stay.

“Everybody I’ve talked to in Washington (D.C.) says that’s notgoing to happen. It’s law now,” he said.