Patients and hospitals face scary and uncertain futures as the nation moves toward full implementation of the Affordable Care Act, said Randy Pirtle, King’s Daughters Medical Center’s chief financial officer, Wednesday.

     Pirtle discussed the health care reform law, often referred to as Obamacare, during Wednesday’s Brookhaven Kiwanis Club meeting. He was particularly concerned about provisions of the law that ultimately could lead to socialized medicine.

     “That scares me a lot,” Pirtle said.

     Pirtle also expressed concerns about health care uncertainty in the face of current unemployment rates that are hovering at more than 8 percent nationally and around 10 percent in KDMC’s primary and secondary service areas.

     With around one in 10 people without a job, Pirtle said the average person will put off preventive care because they cannot afford it. As a result, blood work and other tests that could detect health-related problems are not done and the issues are not discovered until the person finally comes to the hospital, often to the emergency room.

     “The patient enters our arena sicker than they would have been had they had these services done (earlier),” Pirtle said.

     Pirtle pointed out the economic impact on the hospital also. He said KDMC had $15.5 million in bad debt in nine months.

     “When the economy suffers, you suffer and the hospital suffers as well,” he said.

     Pirtle said the $15.5 million total represents 24 percent of the hospital’s net revenue. That revenue is used to pay for a wide variety of hospital operations.

     Pirtle discussed some aspects of Obamacare. Some provisions are already in place and many are to take effect in 2014.

     States are expected to create health insurance exchanges for individuals and small businesses to provide access to coverage as required under the individual mandate provision of the law. Pirtle said subsidies would be available to help those making up to 140 percent of the poverty level.

     To help pay for the law, there will be a 3.8 percent tax on certain kinds of investment revenue. Pirtle also mentioned a 10 percent tax on tanning services and other revenue efforts.

     The expansion of Medicaid, a joint state-federal program to provide care for the poor and disabled, is another part of the law. That topic has been a hot-button issue as state leaders across the nation ponder whether to go along with the expansion and the initial influx of federal dollars it would bring.

     “Some states are going to expand Medicaid, some are not,” Pirtle said.

     Mississippi’s Republican leaders have so far rejected the idea of expanding Medicaid, saying it could be a “budget-buster” and cause financial problems down the road. Medicaid expansion supporters contend Mississippi, as one of the poorest states in the nation, cannot afford to turn down the additional money the law would bring.

     When asked his opinion, Pirtle said he was torn on the Medicaid expansion idea. He said the expansion would bring in more money, but he was concerned about health care related sacrifices that could further open the door to socialized medicine.

     Regarding the individual mandate provisions, Pirtle said starting in 2014, everyone must have insurance or pay a $695 fine. Businesses with more than 50 employees must offer insurance or face a $2,000 fine per employee per year.

     Pirtle worried that businesses in that situation could simply opt to stop offering insurance and pay the fine. That, in turn, could push more people to the insurance exchanges, socialized medicine and more patient treatment in emergency rooms.

     “Careful what you ask for,” Pirtle said several times in discussing the law and its potential impact.