October 28 2014
Patrice J. Lee
One of the biggest broken promises of ObamaCare was that if you like your doctor you can keep your doctor. Now, many Americans who fell for ObamaCare can’t find doctors willing to take their ObamaCare coverage. What good is a healthcare plan, if you can’t actually find a care provider?
Open enrollment for ObamaCare is a matter of weeks away. After the election, we’ll see the Administration pounding the pavement to convince more Americans without healthcare coverage that ObamaCare is the best deal for them. They’ll talk about lower healthcare costs– which are artificially held down by taxpayer-funded subsidies– and they’ll tout access to care.
The problem is that doctors and healthcare providers aren’t lining up to accept ObamaCare patients because the reimbursements are lower than even Medicare and Medicaid reimbursements – which are pretty low as is. As for those who are accepting ObamaCare, they are limiting the number of such patients they accept so that they can remain solvent.
Doctors also report a host of complaints with ObamaCare patients, many of whom are carrying healthcare coverage for the first time and don’t understand their plans and expected out-of-pocket expenses.
Because these exchange plans often have lower reimbursement rates, some doctors are limiting how many new patients they take with these policies, physician groups and other experts say.
To prevent discrimination against ACA policyholders, some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans unless the doctors' practices are so full they simply can't treat any more people. But lower reimbursement rates make some physicians reluctant to sign on to some of these plans or accept too many of the patients once they are in the plans.
Kleinman says his members complain rates can be 50% lower than commercial plans. Cigna and Aetna, however, say they pay doctors the same whether the plan is sold on an ACA network or not. United Healthcare spokeswoman Tracey Lempner says it's up to their physicians whether they want to be in the exchange plan networks, which have "rates that are above Medicaid." Medicaid rates are typically below those for Medicare, which in turn are generally lower than commercial insurance plans.
Jon Fougner, a recent Yale Law School graduate, sued Empire Blue Cross this month because he couldn't find a primary care doctor in his new ACA exchange plan.
Fougner's experience underscores how important it is for consumers to check out doctor and hospital networks for plans before they purchase them -- and to call doctors to make sure they are accepting new patients with their policies.
Among 30 doctors he called, Fougner said, they either weren't taking new patients, weren't in the plan or didn't return calls, or the contact information proved incorrect.
This shouldn’t surprise us. ObamaCare distorts the healthcare market and causes insurers and providers to respond in ways that protect their businesses. Much of this doctor shortage is because insurers are narrowing the networks of doctors and hospitals in their exchange plans to help them reduce costs, but then that means consumers have difficulty finding doctors who will take them.
Doctors report that life with ObamaCare is no paradise. As noted above, the reimbursement rates are low, which means that they can’t take too many ObamaCare patients or they will find themselves out of business.
They also complain that consumers with a federally subsidized plan get a 90-day grace period before plans are canceled if they don't pay their premiums. Doctors must go after patients to pay for their services as insurance companies refuse to pay the claims. That’s a challenge.
Also, plans with the lowest premiums require consumers to pay the most out of pocket but consumers don’t understand how much they have to pay, so doctor's offices have to spend a great deal of time explaining benefits packages.
There’s a lack of transparency that both consumers and providers are finding with the entire ObamaCare system. Doctors want to know more about the coverage that new patients have so they can determine whether to take them. Some doctors are asking that ObamaCare cards be printed with the insurance plans on them. Consumers want to know how many doctors listed as accepting ObamaCare actually have not maxed on out on the number of patients they’re willing to see.
ObamaCare is not the good deal that the President tried to sell the American people on. It’s like those seen-on-TV products that promise to make your life so much better, but when you open the package you realize it’s just a dud.