Head of Orlando Health prepares for Affordable Care Act

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ORLANDO, Fla. - One of central Florida's largest employers is about to go through a major change in the way it does business.

The Affordable Care Act will begin enrollment on Oct. 1, and Orlando Health representatives said they are bracing for it.

Sherrie Sitarik, CEO of Orlando Health, said she is dealing with three major issues right now. She said she has nurses threatening to form a union, the state of Florida has reduced Medicaid reimbursements by millions of dollars and the Affordable Care Act is about take effect.

Orlando Health is ranked fourth in the country in providing indigent care -- helping more people who can't pay than any area hospital.

"Part of the reason -- Orlando Health has been a safety net hospital for this community for 100 years," said Sitarik.

Sitarik said because of a $114 million loss last year from helping the uninsured and from others not paying their bills, the hospital is trying to bring costs in line.

"There is not another industry I know, or business where you have to take care of people that come through your doors regardless of their ability to pay," said Sitarik.

Sitarik said in an effort to bring costs in line she will cut differential pay, beginning in January.

Differential pay is the amount of an hourly wage increase an employee gets for working odd hours.

Added to the issue for Sitarik, the Florida legislature hasn't accepted a $51 billion expansion to Medicaid from the federal government, meaning that the Affordable Care Act might mean more people go uninsured.

"Right now, our legislature has not approved Medicaid expansion, so a lot of people are still going to be uninsured that are not going to qualify for health care exchanges and aren't going to qualify for Medicaid as well," said Sitarik.

Sitarik said it will be at least two years before how effective the Affordable Care Act is, because some people will still be in the "black hole" of no coverage.