The rubber meets the road in the coming years as people begin to actually "access" the care they need from healthcare providers.
People are narrowly focused on their insurance payments, co pays, etc now. The tsunami of changes are coming in healthcare facilities, docs, services, products, devices, drugs that no one is really considering at this point. Hospitals treating patients in communities without a strong commercial payer, cash paying base will find it hard to financially survive. Its driving enormous consolidation now across systems.
These smaller community systems are actively seeking to be bought or managed because they are going bankrupt. The ACA along with other CMS reforms are accelerating this occurrence.