My young co-worker was involved in a terrible crash with a drunk driver and didn't have insurance. Ten years later, she was still paying off the plastic surgery that restored her face.

A major requirement of the Affordable Care Act is that everybody, especially young people, buys health insurance, and a big argument against it is that the so-called "young invincibles" won't sign up.

They don't feel all that invincible, according to U. S. News and World Report, which reports studies and polls showing that young people understand the importance of health insurance and will sign up for insurance if it's affordable. For them it hinges on the ACA tax credits offered to lower-income people. Young people are now the targets of pro and con forces, plus the insurance industry. They've never been so loved.

Still, when ACA opens shop on Oct. 1, nobody knows exactly how it's all going to work. Which is why, with all the hysteria and venom out there, I keep returning to healthcare providers. They don't have the luxury of political speculation.

ACA will go forward, predicted Clay Holderman, chief operating officer of Presbyterian Healthcare Services' central delivery system. "It will be imperfect, and some pieces will be delayed, but it will roll forward."

Holderman was on a panel of healthcare providers last week speaking to real estate developers and their fellow travelers who wanted to know if there were business opportunities in Obamacare. It turns out there are, and their opportunities offer something for the rest of us.


With roughly 200,000 New Mexicans entering the system and ACA's emphasis on cost reductions, the big systems must shift care from the emergency room to primary care, which they all agreed is a welcome change. The ER is the most expensive place to treat people. So are hospitals. So they also see a de-emphasis on hospitals and movement toward beefed up primary care in your neighborhood shopping center.

Primary care used to be a doctor, a nurse and support staff. The new primary care center will look more like a team with behavioral health counselors, pharmacists and other disciplines. And instead of a doctor talking to you about how to manage your diabetes, you will probably attend a group session with other diabetes patients.

"Regardless of ACA or other legislation, we've seen a sea change in how healthcare is demanded and delivered, especially with the recession," said Stephen Forney, vice president and chief financial officer at Lovelace Health Systems. He predicts small hospitals in rural areas will go out of business. "Not every community needs a hospital - they need other kinds of care - more physician practices, more surgical centers, a higher utilization of technology."

Technology comes in two varieties. One is the electronic record keeping required by ACA. Holder said Presbyterian has spent more on electronic records than it did to build the big, new Rust Medical Center in Sandoval County. The other kind is technology used in healthcare delivery.

"Today, we're monitoring Española ICU patients from Rust Hospital," he said. He sees entire divisions dedicated to telemedicine.

Technology isn't always the answer, said Martin Hickey, CEO of New Mexico Health Connections. Modern pharmaceuticals can do great things, but they only work if you take them. An emerging care giver is the community health worker who will help high-risk patients maintain a program and stay on their meds. "That's where the huge change is," he said, and the community health worker needs only a high school diploma.

Hickey is also becoming the voice of reality in the ongoing, politically driven arguments. Reminding this crowd of employers that returning to the status quo isn't an option, he said, "Spending 18 percent of GDP (gross domestic product) on healthcare will ruin this country. Your costs need to come down."

Sherry Robinson is a columnist for New Mexico News Services.