Like it or not, the healthcare reform bill is now law. Many presidents have tried to achieve reform, and they paved the groundwork for President Obama. But what does reform really mean?

This is a complex plan that will be implemented over multiple years. It offers both promise and concern moving forward. In the “promise” category, I would list the 32 million additional Americans that will have health insurance once the law is fully implemented. In New Jersey, that translates to approximately 920,000 of the 1.3 million New Jerseyans who currently lack insurance. That is a positive step forward.

In the “concern” category I have a couple of thoughts: The broader coverage comes from expanding Medicaid and providing coverage by yet-to-be-created State Insurance Exchanges. I worry about Medicaid because some physicians won’t accept Medicaid right now; will the newly insured be able to find a doctor to provide care? And will there be enough physicians to see all of the newly insured since several projections show we are on the verge of a physician shortage? The news media is full of stories regarding access problems once Massachusetts implemented its reform plan. According to the stories, the good news is that Massachusetts residents now enjoy broad insurance coverage. The bad news is that it now takes six months to get a doctor’s appointment.

Another concern I have with the Medicaid component of the coverage is the burden it will place on all state governments. Here in New Jersey, Medicaid is a program that is funded 50 percent by the state and 50 percent by the federal government. As Medicaid is expanded, it will cost every state more money. With so many states in fiscal crisis – including New Jersey – how will they respond to this new demand? In the short term, the federal government is providing an enhanced rate for Medicaid to each state, and that is a very good thing. But what happens when that enhanced rate goes away?

One final concern that continues to nag me as I look to the future under healthcare reform: Hospitals will sustain reimbursement cuts to the tune of approximately $155 billion over the next 10 years as the law becomes fully implemented. That’s a great deal of money, and NJHA is working closely with New Jersey’s congressional delegation to ensure that these cuts are carefully calibrated to roughly match the number of newly insured patients hospitals and physicians will be treating. We’ll also be working closely with the State of New Jersey, because much of implementation (the creation of the insurance exchanges, for example) will take place on the state level.

The law’s implementation bears a very close examination moving forward. But no one said it would be easy. As Health and Human Services Secretary Kathleen Sebelius told the National Press Club recently, “There will be bumps along the way. There will be twists and turns. It will not be easy. But, after decades of standing still, we are finally moving forward.”