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October 12. 2013 8:19AM

Saturday Six Pack: Al Felgar, CEO of Frisbie Memorial Hospital

For a hospital executive, Al Felgar, CEO of Frisbie Memorial Hospital in Rochester, has been unusually outspoken about the Affordable Care Act. I asked him about the act and Medicaid expansion this week. His perspective helps poke through some of the puffery about those issues, I think.

1. You have disputed the claim that Obamacare will keep prices down by increasing competition. Why don't you believe that? It's called the "Affordable Care Act," after all.

Only one insurance company's plans are offered. There is no price competition-more companies in the insurance exchange would help. And, providers were not given the opportunity to compete on price. Anthem excluded 10 hospitals and their doctor networks without ever discussing their interest in participating or pricing.

2. What do you see as the largest driver of health care costs, and how well does the Affordable Care Act address that problem?

Demand for medical services by the public. US "costs" are high in part because Americans want lots of medical care (MRI's, CT's, Hip replacement, etc). The ACA will not impact that very much.

3. If not Obamacare, how would you change health insurance system to increase access to care and lower costs?

New Hampshire needs to change laws on underwriting to encourage more insurance companies. Fifteen years ago we had many more insurance companies. More insurance companies would mean they would have to compete to sell their products to employers. In order to compete, they would need to lower the premiums.

4. Would you prefer to see the state expand Medicaid eligibility or try for an alternative, and why?

Expanding Medicaid is a two-edged sword: it would help Frisbie (less bad debt), but expanding Medicaid will obligate N.H. state government to future financial obligations.

Where will this money come from? More taxes?

5. Are you optimistic or pessimistic about the future if Obamacare is not changed?

Pessimistic. Ten hospitals and their doctors networks are excluded from the program. Access will be greatly restricted.

6. Most people hear "Frisbie" and think of the flying disc. Can the hospital cash checks written to Frisbee Memorial Hospital, and to your knowledge have you ever admitted a child with a serious Frisbee injury?

Appreciate your sense of humor. I will ask a few ER docs regarding the injury question.

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