The biggest threat to Obamacare (after voter rage at massive increases in premiums and deductibles and restricted selection of doctors) is the "Death Spiral". Since Insurance companies cannot legally sell policies to sick people at a higher price than to well people (the whole "pre-existing conditions" thing), the fear is that higher premiums will discourage younger, healthier people from signing up. Since the customer base will skew to sicker (and higher payout) customers, Insurance Company profits will turn to losses and companies will have to raise rates. This will drive more healthy people away until only sick people are left, when the whole thing collapses.
So let's look at hospitals and uncompensated care. It's actually wrong - as a matter of law - to say that the uninsured in the USA do not have access to health care. By law, Emergency Rooms cannot turn people away, even if they cannot pay. This "Uncompensated Care" is a major existing cost currently borne by the insured (via higher policies). Ignoring the fact that this more or less guts the entire rationale for Obamacare, what incentives does the Obamacare statute give to Hospitals to game the system?
How about buying insurance for the uninsured patients who make up the bulk of their uncompensated care?
In this case, the Administration was faced with questions from Representative Jim McDermott. He asked if exchange-sold health plans were considered Federal Qualified Health Plans (QHP) under the law. If so, he pointed out that several of the things the Administration had discussed (e.g. allowing insurers to offer monetary inducements to customers who maintained good health habits) could be illegal under anti-kickback provisions.Oops. Now that the Democrats voted for it, Secretary Sibelius is finding out what's in it. This whole redistribution thing is a lot more difficult than they had thought.
As usual, it was pretty clear the Administration had no answer. Or more accurately, had five different answers from five different people and agencies. Kathleen Sebelius wrote back to McDermott that no, exchange sold plans were not QHP's and so the anti-kickback law did not apply. This tactically solved McDermott's issue. But it created large new issues, since it is the anti-kickback law that would have prevented hospitals from buying exchange plans for their most expensive patients. If exchange plans are not QHP's, then hospitals considered that buying such plans was now legal.
Oh honestly, it really is pointless trying to do this if you're going to cheat ...