That brought an objection from UM President Donna Shalala, who served as secretary of Health and Human Services during the Clinton administration. She argued that many companies are building part-time worker pools simply to avoid providing insurance, and it made sense for the law to help part-timers.

Shalala also noted that the law is designed to help people who now have “lousy insurance,” with such high deductibles or other limits that the people tend to avoid healthcare.

Many speakers noted that the law makes only small steps toward controlling healthcare costs. All agreed that cost containment is necessary to keep healthcare from overwhelming the economy. But that could be difficult.

But a 1997 act sought to limit Medicare payments if the program was losing money — and every year since, doctors groups have successfully battled cuts to maintain their payment levels.

“The quickest way to clear a room on Capitol Hill,” said Ignagni, was to talk about cutting healthcare costs, because that would mean losing jobs. She estimates that over the next decade, Washington needs to cut $1 trillion or $2 trillion out of healthcare spending.

The reform act attempts to reduce cots by creating accountable care organizations, in which groups would join together for coordinated care that many believe would reduce duplicated services and reduce costs. This ACO trend means that many hospitals and other groups are consolidating to form larger organizations.

But Robert Galvin, former chief medical officer of General Electric cited a study of about 20 markets where there has been consolidation of healthcare businesses. With less competition, he said, “prices are up. ... Right now I’d say we’re losing that battle.”

Summing up one panel discussion, Richard Clarke, former president of the Healthcare Financial Management Association, noted there has been a “shift in focus from acute to non-acute care, from federal to state controls. So I guess you have to say shift happens.”

NOTE: An earlier version of this story misspelled the name of Steven Ullmann and gave the wrong numbers in an example on younger and older workers.