Friday, October 31, 2014

Physician Nightmare over ObamaCare

ObamaCare has turned into a nightmare.

A physician commenting on health exchange health plans

It'e Halloween, four days before midterms, and it’s turning into a nightmare, not as portrayed by horrifying ghosts and goblins, but as realities for practicing physicians, health exchange patients, and ObamaCare partisaans who foresee spooky dangers lurking around the corner and political ghoulies that go bump in the night.

The nightmare? The Medical Group Management Association (MGMA), the largest association representing physician groups, has just announced, based on a survey of its members, that 214,524 physicians, out of 893, 851 practicing physicians(Kaiser Health estimate) will not be accepting patients who enrolled in health exchange plans. The number, 214, 524 is staggering because it represents one-fourth of practicing physicians, 24.0% to be precise, and the U.S. already has physician shortages of 50,000 or more.

Physician Nightmare

To physicians, millions of new health exchange patients represent a potential nightmare.

Why so?

1. Low reimbursements – 40% less than private plans, 20% less than Medicare, on par or less than Medicaid which is less than Medicare.

2. A tsunami of new patients, sicker than most, superimposed on already overloaded and overbooked practices.

3. Health exchange patients, 75% of whom have high deductibles, which low-income patients must pay, leaving doctors stuck with unpaid bills.

4. ObamaCare says patients must be covered for 90 days, insurers will cover for 30 days, leaving the doctors with a collection nightmare, the number one reason doctors and their practice managers give for not accepting these newly government insured patients.

There is another likely reason – physician suspicion and lack of support of ObamaCare. In a recent Physician Foundation survey of 20,000 physicians, 46% gave a ObamaCare a grade of “D” or “F”, and only 4% gave it an “A”.

In any event, ObamaCare is asking doctors to take sicker patients for less with greater risk of not getting paid. The MGMA summarizes the problem, “ Chief among them (reasons for not accepting exchange problems) is the fact that exchange plans are more likely to offer significantly lower reimbursement rates than private market plans, confusion among consumers about the obligations associated with high deductibles, and fear that patients will stop paying premiums and providers will be unable to cover their losses.”

Health Exchange Patient Nightmare

These numbers raises questions: What good is federally-subsidized insurance for patients if too few doctors exist to care for them? What happens if it becomes exceedingly difficult to find doctors? Or if long waiting lines make access to physicians and health care burdensome? There is Medicaid, of course, but the number of doctors accepting Medicaid, is 30% or less, and well below 50% in many regions of the country. And there are community clinics, designed to care for the poor and the uninsured. But for some patients, Medicaid and community clinics smack of social welfare and low-quality care, even if these attitudes are not deserved. And, increasingly, there is more self-care and more direct cash-only care in walk-in clinics and concierge practices.

Political Nightmares

For physicians and politicians there are political nightmares. Physicians will be portrayed as more interested in money than in the health of their patients. And ObamaCare backers, particularly Democrats who voted for the health law without a single Republican vote, will be viewed as supporting an unpopular President and an unpopular law, a law which the latest CBS/WSJ poll indicates only 36% of Americans favor while 55% disapprove.

For the moment at least, four days before the midterms, the Good Ship ObamaCare seems to be listing, in danger of sinking.

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