Health care policy isn't what you think about when you roll into a hospital emergency department or check in at the admitting desk to prepare for a procedure. In fact, it's probably the last thing on your mind. What you're concerned about is getting the best care in the best environment available. Ultimately, however, health care policy determines if that hospital is waiting for you.

The 2012 election has moved the health care debate to the forefront, which is good. A robust debate about the direction of the health care system -- whether the Affordable Care Act or the future of Medicare -- is important for designing the future health care delivery system to meet the needs and desires of patients and families. However, the ongoing nature of the debate complicates hospitals' ability to make investments.

The Missouri Hospital Association has released a new study identifying some of the most significant health care policy issues for the state's hospitals. The study focuses on issues that are unknown but could potentially affect hospitals in Missouri, including the 2012 elections and the pending decision by lawmakers to expand Medicaid through the ACA. It also addresses trends that are clearer, such as economic and demographic trends, consolidation in health care and the impact of technology and performance improvement.

In broad terms, what the research indicates is that Missouri's hospitals will be challenged by the confluence of state and national policy decisions, fundamental shifts in the way the health care system operates and Missouri's poor community health indicators.

Cuts to entitlements, especially significant federal cuts to Medicare, could jeopardize hospitals and physicians and limit access to care. The state's uncertainty to expand Medicaid as outlined in the ACA would harm hospitals that surrender federal funding to offset the cost of care with the expectation of expanded coverage. Entitlement reform will require individuals to make decisions about their values. And, significant cuts to these federal health programs will affect both the enrollees and the costs of care for all Missourians.

The difficult financial climate has led to integration in health care. More hospitals are aligning through partnerships, mergers and acquisitions. And, the number of physicians who are seeking hospital employment is increasing. Although these trends can bring additional assets for patient health, the sharing of technology and streamlining of patient transitions are important and costly investments, and the history of integration is uneven.

Missouri's population is older, poorer and sicker than many other states. This will present challenges to hospitals as emphasis is placed on improving the health of our communities and payments that depend on improved performance. No member of the provider community can independently influence these metrics. It will require a coalition of health care providers and community leaders to improve Missouri's health indicators.

Missourians deserve great hospitals. And, despite the turbulent and challenging issues hospitals currently face, we're committed to delivering the best care to the communities we serve.

Health care policy is important, especially because it affects the patients that Missouri's hospitals serve every day.

Herb B. Kuhn is president and CEO of the Missouri Hospital Association.