The top executives from AMN Healthcare Inc. (NYSE: AMN), Jackson Healthcare, Medicus Healthcare Solutions and Supplemental Healthcare — representing more than 20% of the healthcare staffing market — weighed in on the ACA, the future of healthcare staffing, the human cloud and more on Wednesday, the last day of Staffing Industry Analysts’ Healthcare Staffing Summit in Dallas.

“I think the overall mood in the room is cautiously optimistic,” said Shane Jackson, president of Jackson Healthcare. The comment kicked off the panel discussion among executives moderated by Barry Asin, president of SIA.

The forecast of 6% growth in healthcare staffing revenue for 2018 is as good a guess as any, Jackson said, although that growth won’t be evenly distributed.

However, some executives took issue with the focus on the Affordable Care Act. Analysts cite the ACA as a driver of healthcare staffing growth in recent years, which reached 20% in 2015. Susan Salka, president and CEO of AMN Healthcare, said there are other important growth drivers, including the improving economy and the aging population.

There’s a lot of focus on the ACA and uncertainty over what might happen with replace and repeal, Salka said. On the other hand, cost control is here to stay and firms need to focus on how they add value.

Concerns also remain over a nurse shortage, and millennial nurses want to work 5% less than nurses from previous generations, she said. On the positive side, Salka said she doesn’t see anything taking the US into a recession within the next year.

The growth forecast for 2018 was directionally right, said Joe Matarese, CEO of Medicus Healthcare Solutions. Growth will continue, but it will slow down.

Matarese also said the “ACA, on the balance, has been very positive for us,” and said it likely won’t really change given that it appears people believe healthcare is a right. It would be “political suicide for people to take insured and uninsure them.”

Both Matarese and Salka said healthcare staffing clients are becoming more sophisticated. And Matarese said the industry needs to be more customer-centric — that discussions at events such as the Healthcare Staffing Summit should focus on clients and physicians.

The executives were also asked about the human cloud.

Lesa Francis, president and CEO of Supplemental Health Care, said the biggest impact of human cloud and online staffing platforms appears to be in other segments such as IT.

“It’s not one of the things that keeps me up at night now,” Francis said. When job boards first appeared, some predicted they would kill off regulation staffing, but that didn’t happen, she noted.

Jackson asked why physicians would use an online platform to handle something such as scheduling themselves when it’s something they outsource now, especially given how valuable a physician’s time is?

“There is a segment of the market that will be attracted to the model,” he said, but the traditional staffing model is not in a death spiral.

Jackson also predicted that in 2027, the biggest surprise will be how little the fundamentals of the healthcare staffing industry have changed.