Norwich - With spending on health care closing in on 20 percent of the nation's gross domestic product, something needed to be done to stem the tide, acknowledged Bruce Cummings, chief executive of Lawrence + Memorial Hospital in New London, during a panel discussion Tuesday at the Holiday Inn Norwich.

And, putting on his figurative "public health hat," Cummings said he could hardly argue with the intentions of the Affordable Care Act's attempts to rein in health costs, deal more effectively with chronic diseases and cover more Americans lacking insurance.

"But when I put on my hospital CEO hat, I can't sleep at night," he said during a Chamber of Commerce of Eastern Connecticut business breakfast focused on "The Changing World of Healthcare."

Among the worries keeping him up: the state's new gross receipts tax on hospitals that cost L+M about $2 million last year and is expected to rise by another $5.6 million this year. At the same time, Medicare reimbursement rates are projected to be 2.8 percent less this year than in the previous budget period, he said.

"That puts tremendous pressure on the organization," he said.

Cummings, often at loggerheads with the Malloy administration as chairman of the Connecticut Hospital Association, said hospitals statewide are paying about $300 million through the gross receipts tax to help shore up the state's budget. He worried that such financial pressures will make it difficult for hospitals to have the "elasticity" to deal with public-health concerns such as Ebola.

Cummings said reforms to the health care system were coming anyway, but the Affordable Care Act sped things up. Unfortunately, implementation of the so-called Obamacare program has been something like "changing tires on a car going 60 mph," he said.

Phil Boyle, business-to-business manager for Access Health CT, noted that setting up the Affordable Care Act implementation program will wind up costing the state about $133 million. Some of the money for the first year was covered by federal grants, but subsequent years of managing the program will be paid for out of hospital taxes, taxpayer contributions and a levy on insurance carriers, he said.

At the same time, hospitals are being asked to shift their business focus away from a higher volume of services and toward the idea of improving value and outcomes, panelists said.

"A whole new paradigm is taking shape," Cummings said. "We had a clash between the major health care problems of our time and the way the system was put together."

The chronic-disease burden had become overwhelming he said, with 5 percent of patients consuming 50 percent of the health care dollars. The United States was spending two to three times more on health care than any other country, Cummings said.

Now, thanks to Affordable Care Act, the state has a marketplace where individuals and businesses can shop for health insurance. Still, Obamacare wasn't a huge shift for Connecticut, where less than 10 percent of the population lacked health insurance, compared with states such as Texas in which a quarter of the populace was uncovered, Boyle said.

Now that Obamacare is available, only 4 percent of state residents lack health care, about half the percentage before the law's implementation, he added.

"We have a market that's vibrant here," Boyle said.

Rob Hecker, employee benefits specialist for Groton-based Morin Associates, said business owners are not mandated to buy into the Affordable Care Act until Jan. 1 - and even then, the law affects only employers of 100 or more full-timers working 30 or more hours. The mandate will apply to businesses with 50 or more employees starting in 2016, he added.

l.howard@theday.com

Twitter: @KingstonLeeHow