Consequences of the affordable care act for sick newborns.

Few arenas of modern medicine have been more efficacious than regionalized perinatal and neonatal intensive care. Regionalized health care has been described as a coordinated system of care “to improve patient outcomes by directing patients to facilities with optimal capabilities for a given type of illness or injury.” The most complex infants are ideally born and cared for at regional high-risk perinatal centers, and large-scale regional referral networks have been successful in ensuring access to these facilities for all women and infants in need. However, driven by lucrative reimbursement for high-risk obstetric and neonatal care, the last 2 decades have witnessed an erosion of regionalized referral systems.