The United States continues to have challenges with their healthcare.  As you pick up the ringing "red phone" to the U.S. president, you have a feeling the president is calling to ask for more healthcare advice. 

The president relates that in the U.S. healthcare system, hospitals account for the largest amount of healthcare expenditures. The president sends you resources to better understand the issue (please review the file, "Hospital finance," the article, "The Impact of the Affordable Care Act on Large Employers- A Retrospective," and the link to a recent study on hospital administrative costs).  In reviewing these materials, you remember that the concept of "margin" refers to the difference between costs paid out by the hospital and revenue received as payment for those costs, and that "payment-to-cost" ratio is the margin expressed as a percent. A positive percent means that payments were greater than costs and a negative percent means that the costs exceeded payment.

With the president on hold, you review all the documents.  When you get back on the phone, the president asks your advice on the following questions:

You reply to THREE of the questions.

- What's the big deal about hospital administrative costs and what, if anything, should be done about them?  (As you answer this question, it's important to remember that the hospital's administrative costs cover the salaries of healthcare administrators). 

- Who is newly covered and how is this achieved?

- What are exchanges and how are different States approaching them?

- What does the Medicaid program have to do with the ACA? How will health insurance premiums be affected?

- What variables are in play in the political debate over the impact of the ACA on cost, access, and quality of care?

- What are some of the key implementation challenges facing state and national policy makers?

- On balance, is the ACA a good or bad law?  Provide a clear, fact-based, non-emotional justification for your conclusion (you don't want to offend the U.S. president and possibly ruin ties between the U.S. and Elbonia).

Please use this discussion area to provide your comments to the U.S. president.