Turned Off by Obamacare, Many Doctors Spurn Exchange Patients


Riffing off a survey conducted earlier this year by the Medical Group Management Association (MGMA), the conservative American Action Forum (AAF) estimates that upwards of 214,000 doctors are declining to serve patients covered by Obamacare exchange health plans. AAF gets that number by extrapolating the MGMA's survey responses across the full population of practicing physicians, so take that number as seriously as you like. But there's no doubt that physicians have real concerns about the president's signature Affordable Care Act (ACA), and that exchange customers are having trouble finding doctors willing to take their business.

The MGMA's finding that 23.5 percent of medical practices are not participating in exchange plans squares closely with a survey last month by The Physicians Foundation in which 28.5 percent of respondents answered "no, and I have no plans to" participate in Obamacare.

Fifty nine percent of MGMA respondents had an unfavorable view of the ACA, while 74.6 percent of physicians surveyed by the The Physicians Foundation gave it a C grade or lower (46 percent give it a D or F).

The survey by the The Physicians Foundation didn't inquire into reasons for grades, but the MGMA did ask about resistance to participating in exchange plans. Forty eight percent pointed to the 90-day grace period during which enrollees must still be treated even if they don't pay premiums (doctors are on the hook for 60 days of that, with insurance companies responsible for the other 30). Red tape is a worry for 32 percent of respondents, with 41 percent citing financial headaches including patients not being able to pick up their share of costs on high-deductible plans. Thirty eight percent pointed to low reimbursement rates (they can be half those for traditional commercial health plans).


In an article published this week, USA Today cited bargain-basement compensation for physicians as one reason exchange customers are already having big problems finding doctors who will see them. "The exchanges have become very much like Medicaid," they quoted the president of the Medical Society of the State of New York saying. "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."

The grace period also featured prominently in that article, since it represents a potentally big expense for doctors (my wife has run into it in her pediatric practice).

Doctor availability would likely be even lower if some insurance companies didn't insist on all or nothing packages, requring practices to accept their exchange policies along with their commercial plans.

Even so, for all of the effort to enroll Americans in Obamacare, there's no guarantee that the doctor will be in for any of them.