If the first two horsemen of the ObamaCare apocalypse were insurance cancellations and rate shock, the third is doc shock: the unpleasant discovery that your heavily subsidized ObamaCare plan doesn't cover your old doctor, and finding a new one is tough, because some doctors don't want ObamaCare patients. USA Today had more news on that subject Tuesday:
Now that many people finally have health insurance through the Affordable Care Act exchanges, some are running into a new problem: They can't find a doctor who will take them as patients.
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.
"The exchanges have become very much like Medicaid," says Andrew Kleinman, a plastic surgeon and president of the Medical Society of the State of New York. "Physicians who are in solo practices have to be careful to not take too many patients reimbursed at lower rates or they're not going to be in business very long."
There follows what seems like a bit of a dispute over how much ObamaCare plans reimburse doctors:
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.
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.
I suppose it's possible Cigna and Aetna have more generous reimbursement policies than other providers, at least in New York, but the rest of the article makes it clear there is a real reluctance among doctors to get involved with these plans. There are also complaints that doctors are required to provide services to people during a 90-day grace period after their insurance plans are canceled, which can leave medical practices chasing patients and insurance companies around for payment, and the sudden appearance of the Second Horseman of the ObamaCare Apocalypse when consumers discover their gigantic ObamaCare out-of-pocket expenses mean they can't afford to use the benefits from their subsidized insurance plans.
This has produced more of the unhappy campers you're supposed to completely ignore while pretending ObamaCare is a success:
"I definitely feel like a bad person who is leeching off the system when I call the doctors' offices," she says.Shawn Smith of Seymour, Ind., spent about five months trying to find a primary care doctor on the network who would take her with a new, subsidized silver-level ACA insurance plan.
Last week, Smith found a practice that would accept her as a patient. Caroline Carney, chief medical officer of MDwise, Smith's insurer, says some doctors "might be participating with us, but just not able to take on new patients. It's at the doctor's discretion."
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.
The name of the game is to tell these people to go to hell, bring a few smiling ObamaCare customers with 90 percent subsidized plans on stage to pose for photos, and declare the program a rousing success. Few actors on the American political stage have ever been as callous as ObamaCare defenders.
This is all very different from the promises made when the Affordable Care Act was passed, just like everything else about the ACA is different than what we were promised. A key feature of the program was that its state-of-the-art web portal would make the business of buying insurance and finding a doctor easier than ever before. (I probably should have warned you to sit down before reading that sentence. My apologies! Remember to breathe slowly and deeply until the fits of hysterical laughter pass.) Instead, we're getting "helpful advice" about the dozens of precautions you should take before buying a policy, assuming you can get HealthCareDotGov to work on any given day. Buying an ObamaCare policy is as complicated as the hazmat procedure you're supposed to follow if you drop one of those curly light bulbs.
To be sure, a degree of complexity would come with any increase in competition. It's hard to get much simpler than "you get the health care plan your employer pays for, period." Many found that arrangement less than optimal because it took consumer choice and individual ownership out of the insurance market. But the end of the USA Today article touts as "good news" the statistic that "the number of counties with two or more insurers is up from 81 percent for the last enrollment to 95 percent this year." You get two choices now? Yippee! Not to oversimplify things, but in order for the magic of competition to work, a fair number of eager competitors are needed.
And while an HHS spokesman assures us having two or more providers in an exchange "should mean more doctors to choose from," I don't know if that necessarily follows, given the problem with doctor choice outlined in the rest of the article. If none of the providers is an attractive choice for doctors, customers still might end up searching for quite a while to find one. And that is not, in any way, shape, or form, what President Obama said it would be like, before plowing a couple trillion dollars of our money into this scheme.
Update: CNS News reports the total number of doctors opting out of ObamaCare nationwide, according to a survey by the Medical Group Management Association, is 214,524... which represents nearly a quarter of all physicians. That's going to become an even more acute problem when the employer mandate, illegally delayed by President Obama, kicks in after the midterm elections. And it will likely get worse as the years go by, since there is less of an incentive for people to go into medicine; since the early days of ObamaCare, there have been fears that reduced compensation and increased bureaucracy would make the profession less attractive, given the enormous cost of obtaining a medical degree.
It should also be noted that the only truly significant "achievement" of ObamaCare to date has been radically expanding enrollment in Medicaid, which doctors have always been less than enthusiastic about accepting, due to the low reimbursement rates and paperwork hassles. Part of the solution to making Medicaid work in a practice has been recouping losses through better-paying private insurance patients, but ObamaCare is taking that option away.
How will the inept, ham-fisted bureaucracy created by ObamaCare solve this problem? Easy: they'll lower standards for medical degrees, soak the taxpayers for subsidies to make medical education cheaper, build a form of indenture into the subsidies that requires new doctors to work for ObamaCare, and when the problem gets bad enough, they'll talk about issuing rules that force doctors to take ObamaCare patients, whether they like it or not. That will also be the point at which the big push to junk the designed-to-fail ObamaCare system and replace it with single-payer socialized medicine will get rolling in earnest; having used government power to create a situation in which the public resents doctors and thinks health insurance is worse than ever, the Left will propose the use of even more government power to "fix" the crisis they created. Every medical problem will be solved with hammers and bone saws from now on.
Update: Fox News reports on "a fast-growing, short-term alternative to ObamaCare that allows customers to get cheap, one-year policies could put the government-subsidized plan into a death spiral."
The plans, the only ones allowed for sale outside of ObamaCare exchanges, generally cost less than half of what similar ObamaCare policies cost, and are increasing in popularity as uninsured Americans learn they are required to get health coverage. The catch - that the policies only last for a year - is not much of a deterrent, given that customers can always sign up for ObamaCare if their short-term coverage is not renewed.
???Applications rose 30 percent compared to last year,??? eHealthInsurance.com Enrollment Specialist Carrie McLean told FoxNews.com.
Other providers said they also see rapid growth in the plans, which have a typical monthly premium of just over $100, compared to traditional plans that cost an average of $271.
???It???s because the product is typically half the cost of ACA plans, and you can chose any doctor or hospital,??? Health Insurance Innovations CEO Mike Kosloske told FoxNews.com.
The short-term plans are cheaper, and they solve ObamaCare doc shock? Give this disaster another year to unfold, and the short-term plan salesmen will be beating eager customers off with sticks.
There are three big drawbacks to the short-term plans. First, they don't get ObamaCare subsidies, which means you have to pay for your own insurance, instead of forcing other people to do it for you. That would tend to make the most heavily subsidized ObamaCare customers reluctant to switch to a short-term plan, especially if they haven't tried to use a doctor yet, and discovered those incredibly huge out-of-pocket expenses. People who don't get big subsidies, on the other hand, are likely to find the loss of taxpayer support a small price to pay for increased access to doctors, and the short-term plans could work out to be cheaper anyway. And then you've got the little complication that certain lawsuits could nuke subsidies for the vast majority of ObamaCare customers anyway...
Second, the insurance providers can decline to renew the plans if customers get sick and make claims. The claims get paid and the short-term plan remains valid for the balance of the year, but it doesn't get renewed. The customer is then free to buy an ObamaCare plan, which famously cannot discriminate against those with pre-existing conditions. That means the ideal customer base for short-term plans is exactly the cohort ObamaCare cannot afford to lose: healthy young people, whose exorbitant taxpayer-subsidized premiums are the cash pipeline between taxpayers and Obama's Little Partners in the insurance industry.
Third, purchasers of short-term plans are technically in violation of the ObamaCare individual mandate, because America is no longer the sort of country where people get to make their own decisions about health care. Politicians and their henchpersons make those decisions for you, serf, and they have decreed that you must purchase a government-approved plan, or pay a penalty. In order to keep the Democrat Party from being exterminated at the polls this year, King Barack I illegally rewrote the law to hold off those individual mandate penalties for people who lost their insurance due to his health-care scheme, exactly the way he promised dozens of times, on camera, that they wouldn't.
But those trans-Constitutional tax/penatlies are coming, and as Fox News reminds us, they'll be up to $695 per year or 2.5 percent of income, whichever is greater, by 2016. Assuming His Majesty doesn't rewrite the "law" again to avoid a Democrat bloodbath in '16, that's going to pretty much kill the short-term insurance market. King Barack won't even have to lift a finger. I wonder if the short-term plans will grow popular enough to create political pressure for keeping them alive, assuming the possible demise of subsidies for the federal exchange in court hasn't killed ObamaCare off by then. The Fox News article says sales have grown by 20 to 30 percent over the past year, especially among the young and healthy, which is a brisk pace. A bit of shrewd marketing after the employer mandate detonates next year could make this one of the great growth industries of 2015.
