Obamacare

Turned Off by Obamacare, Many Doctors Spurn Exchange Patients

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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).

MGMA

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.

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  1. Nice little license you’ve got there, doc. Shame if something should happen to it.

  2. Anecdotal:
    My wife’s doc does not accept exchange health plans. My doc does not accept exchange health plans. My kids’ pediatrician, who is in a large medical group, does not accept exchange health plans. The hospital where my kids were born does not accept exchange health plans. The hospital where my wife had her breast tumor removed does not accept exchange health plans.

    As far as I can tell, plans sold on the CA exchange are worthless.

    1. My doc doesn’t take them either.

    2. it’s not real insurance

      1. Still, if you like it, you can keep it.

        1. But it’ll cost you twice as much next year.

          1. BUY an Exchange Plan now and get 12 months of coverage for the price of 9!

            DOCTORS can’t sue you
            INSURERS can’t sue you
            HOSPITALS can’t sue you
            PHARMACIES can’t sue you
            SUERS can’t sue you

            You’d be crazy not to!!!

    3. A couple years ago I switched to the company’s silver plan, which is the employer subsidized version of an exchange plan. Everyone dropped them. This year we got an option from a second insurer, and they offer some cheaper plans, including a PPO for only ten dollars more per biweekly pay period than the silver plan. Problem is, the silver plan went up about sixty bucks a pay period. So now I’ve got the PPO, and hopefully our old doctors, at the cost of another hundred and fifty bucks a month. Haven’t seen a raise in four years. Sucks.

    4. Another anecdote: a doctor that lives in my neighborhood is moving… To panama.

      1. Somalia would have been more appropriate.

  3. 87% said “It’s like doing business with the mob — once you accept an exchange patient, there’s no way out except death or bankruptcy.”

  4. The Obama people will talk about “expanding coverage to more people” like having health insurance is the same as getting medical care. Medicaid is the same scam. More people are covered via the Medicaid expansion. Good luck finding a doctor or facility who will accept it.

    1. In New Mexico, 70% of the births are paid for by Medicaid. Its so common that after our kid was born and ended up in ICU for a week, the first thing the paymaster asked us was if we wanted to make a Medicaid claim for the kid’s treatment.

  5. I call shenanigans here. From the MGMA survey:

    62% of respondents reported moderate to extreme difficulty with identifying a patient that has ACA exchange coverage as opposed to traditional commercial health insurance.

    If I go on the exchange and get, as an example, and Aetna exchange plan, the doctor just knows I have Aetna insurance. They have no idea whether I’m an exchange patient or otherwise.

    I’m betting most of these doctors don’t really know whether they take exchange patients or not, they’re just responding as to whether they like the law or not.

    1. More from the MGMA survey:

      Our practice was not approached by payers in our area with contracts for any ACA exchange products 41.8%

      Which again likely means they’re covering exchange patient products under their existing contracts and they just don’t realize it.

      1. Skimming one of the articles, my understanding is that the network is different for exchange plans.

        If they opt out of being in-network for exchange plans, then they’re not covering exchange patients.

      2. 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.

        1. some insurance contracts require doctors to accept their exchange-plan patients along with those on commercial plans

          So as I said, there’s probably a lot of doctors treating exchange patients without realizing it.

          1. deductibles, copays, reimbursement rates. I’ll bet they know just exactly who is who. I doubt it is all a big reveal at the end of the visit/procedure.

            1. I’d be interested to see a survey of the insurers on what percentage of their provider networks accept their exchange plans and see how well it matched up with the MGMA results.

              1. what percentage of their provider networks accept their exchange plans

                Well that’s easy, 100%.

                Or do you mean what percentage of their providers who accept at least one of their plans will accept their exchange-rated plans?

                The provider network is going to be determined by the terms of the coverage. There’s no insurance plan offered that will be accepted by absolutely every doctor, and I don’t see how “insurers who accept some form of insurance” is the natural population from which to draw the sample of “insurers who accept this form of insurance”.

                1. Put another way, the information you’re asking for kind of reminds me of how (horribly) unemployment is calculated. You can make things look artificially rosy by playing games with the denominator.

      3. Our practice was not approached by payers in our area with contracts for any ACA exchange products 41.8%

        Which again likely means they’re covering exchange patient products under their existing contracts and they just don’t realize it.

        The exchange policies are typically narrow networks, meaning that they exclude a lot of doctors and hospitals.

        The insurers have the data to see who the “low-cost” providers are. Those are the ones to build a narrow network on. The “high-cost” providers wouldn’t even get a call.

        I find it very plausible that a lot of doctors were never even asked.

    2. If I go on the exchange and get, as an example, and Aetna exchange plan, the doctor just knows I have Aetna insurance. They have no idea whether I’m an exchange patient or otherwise.

      They know, because the exchange policies have different networks and different benefit structures.

      A competent practice administrator can tell you which Aetna policies/patients are exchange patients, and which are not.

      1. MGMA members are practice managers–physicians who run their own practices or else professional practice administrators–and are very likely to know the plans in which they participate.

    3. Employers are offering plans similar to exchange plans, the difference being who subsidizes them. A couple years ago I switched to what I now know to be an ACA plan at my work, and then next thing I knew all of our doctors dropped us. The next year I learned it was the equivalent of a silver exchange plan.

      During the last enrollment I dropped that plan for a more expensive PPO. Hopefully our old doctors will take us back.

    4. Well Holy Shit, how completely unsurprising you sleaze in here to defend Obamacare.

  6. Is anyone really surprised by this though?

    Obama got to say “I brought affordable health care to millions who didn’t have it”.

    He didn’t have to admit that “He” didn’t really do anything other than hand over other tax payers money to pay for subsidies for health insurance for poorer Americans. He also didn’t have to admit that forcing insurers to accept more expensive customers with pre-existing conditions forced the insurers to raise the insurance costs on their paying customers.

    He basically got to fuck over 2/3 of the nation so he could say he gave worthless health insurance to poor people that weren’t poor enough for Medicaid.

    1. Sounds exactly and precisely like what Obama would do. Utterly self-serving, mendacious, narcissistic, and sociopathic levels of not giving a shit what it does to people’s health care. Yup, sounds just like Obama.

    2. It’s like when a politician raises the minimum wage and declares that they gave poor people a raise.

      No, the politician pointed the figurative gun of government at employers’ heads and demanded they pay their employees more.

      1. Which, by the way, makes leftists swoon.

      2. Yeah, like Epi said, it’s right in line with the Narcissistic Sociopath in Chief.

    3. Better yet, people with money or good jobs still (for the time being) get access to decent health care, but the poor don’t, thus creating a two-tiered system. If a Republican had passed this bill…

  7. MGMA’s survey responses across the full population of practicing physicians, so take that number as seriously as you like.

    Not seriously at all.

  8. 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.

    And back to emergency room care you go, Medicaid patient…only with fewer doctors to help you out.

    Enjoy. You got what you asked for.

  9. OT:

    Not sure if you guys saw this yet, but it’s a classic.

    Obama’s Secret Service Agents Pay a Visit to Conservative Street Artist, and Things Get Interesting

    http://www.ijreview.com/2014/1…..ns-tables/

    1. That’s how Secret Service agents dress these days?

      I like a lot of his art, but the “man with a rifle” tweet was kind of stupid. It’s best to not give the authorities an excuse to harass you.

      1. Yeah that was dumb.

  10. The BBC says child sexual exploitation is becoming a ‘social norm’ in parts of Manchester, but strangely enough they never seem to mention who the people molesting children are. Hmmmm…this almost makes me think that the BBC might be hiding something that they don’t want to let their readers know.

    1. Why ask such a silly question. It’s white christian males doing that molesting. Everyone knows it.

      1. I thought it was all Catholic priests.

    2. I am still skeptical of this ‘epidemic’ if child sexploitation it sounds like the molester outbreak of the ’80s. We have Muslims in Calgary and we don’t have these problems.

      1. I am still skeptical of this ‘epidemic’ if child sexploitation it sounds like the molester outbreak of the ’80s. We have Muslims in Calgary and we don’t have these problems.

        I mean, they had entire classes of girls getting cliterodectomies in Sweden.

      2. Perhaps the authorities in Calgary are not as totally in the thrall of PC thought as the Labour Party authorities in Rotherham.

        I believe they know of about 1400 cases in Rotherham, so the term “epidemic” isn’t too much of a stretch.

        1. Aren’t those 1400 ‘cases’ born of extrapolation in a study? Risky.

    3. I was unable to open the link on my phone. So who’d the molesters end up being — Man U or Man City?

    1. The best part? It’s Frederick County, i.e. one of the less populous and more conservative counties, thus not likely to be anywhere near the state average rate (one in seven!) of non-citizens. Whatever’s going on there is but a drop in the bucket compared to Montgomery, Prince George’s, Baltimore, Howard, etc.

      1. I love Frederick. I seriously want to move there. But yeah, it’s like you say, if there is a problem there, then it is likely much worse in the counties that you mentioned.

        1. I grew up in Frederick. You really get sheltered from how fucked up this state is when you live outside its population centers. Even Frederick City, bastion of shitty progressive government that it is, is nothing compared to Baltimore or the DC suburbs.

      2. If I were a Democrat puppetmaster, that’s exactly where I’d send the illegals to vote. No point in having them shift a 70-30 Dem victory in Montgomery County to an 80-20 Dem victory — you want them shifting a 55-45 GOP victory in Frederick to 55-45 Dem victory.

        Sort of like an inverse Free State Project.

        1. They already got the U.S. Congress seat through redistricting, there’s no way in hell the Democrats take control of the county government, and the only thing really up for grabs right now is the governor’s seat, which can be swung from anywhere in the state. So I don’t think the Democrats would find you to be a very good puppetmaster for this election. Plus the sheriff of Frederick County would run your “puppets” out on a rail if he could find an excuse.

          Moreover, they’ve never stopped at 60, 70, or 80 percent control before, why would they start now? All 80-20 means to them is they haven’t worked hard enough to get 85-15.

          1. Hmm, doing some reading, I may be out of touch with the current state of county politics.

    2. I keep being told that I’m not really a libertarian if I am concerned about mass illegal immigration, and here we have evidence that it’s swinging elections to Democrats. Told you so….

      1. How’s about we wait for a more credible source to come forward with solid proof before you get your border wall boner hard?

        1. I live in MD and I am pretty sure it’s going to turn out to be true. And this is a very serious problem, nothing to joke about.

          1. Unconvincing. I need proof.

            1. I’m sure you’re going to get it.

        2. Yeah, well, you’re someone who refuses to see any connection between a mass influx of illegal immigration, followed shortly by a distinct rise in measles, TB, EV-D68, and other diseases.

          1. Of course, again, this is reflective of the cravenness and incompetence of the government. This “mass influx” is a problem created and nurtured by the politicians who stand to benefit from it.

          1. That’s actually pretty amazing considering the anti-vaxxer limousine liberal havens in California.

            1. It’s not news for this administration to do something against the interests of its voters and donors.

        3. How’s about we wait for a more credible source to come forward with solid proof before you get your border wall boner hard?

          All the sudden, the open borders crowd becomes Cartesian skeptics.

        4. Cute, coming fro the “murder all brown people” Canadian chickenhawk.

      2. We are so far down the rabbit hole that nothing that happens can be said to be due solely to a particular factor.

        Hell, the “mass illegal immigration” (still kinda stunned by that 1 in 7 stat, it’s truly baffling for a state that is far away from any international border and whose largest employer is the fucking US government) is largely about incentives created by politicians using other people’s money.

        In a society with strong respect for property, you don’t see that kind of shit. People migrate when and if they can afford to, not because they just feel like it. Really, what we have in this country is immigration cronyism: move here, vote for me, and I’ll make sure the police don’t hassle you and the welfare application doesn’t get too much scrutiny.

        The whole “shuffle ’em around” bullshit that Obama recently pulled with those illegal kids (never mind what he did in the first place to cause them to be here) is hardly evidence of libertarianism in action.

        You’ll never find a stronger advocate for voter ID and other anti-fraud measures than me. I know the consequences of perverse incentives. But trying to turn the country into a maximum security prison is no less destructive of liberty and the economy than a crony-welfare state in the long run.

        1. Really, what we have in this country is immigration cronyism: move here, vote for me, and I’ll make sure the police don’t hassle you and the welfare application doesn’t get too much scrutiny.

          So basically, the same thing that happened in urban America from about 1870-1920?

          1. It is truly amazing the things people don’t riot over.

          2. So basically, the same thing that happened in urban America from about 1870-1920?

            Which caused a great deal of social upheaval, including contributing to the rise of the KKK, the Mafia, and the Red Scare.

            And which involved quarantining people on Ellis Island and Angel Island, and sending a lot of them back.

  11. On top of the healthcare clusterfuck……

    I just got back from the grocery store. A hundred bucks filled two plastic grocery bags. Ground beef is three dollars per pound.

    Where is that miserable little cocksucker shreek? I would love to knock his fucking teeth out of his lying mouth.

    1. You’re shopping at the wrong place. I mean, I do shop at expensive markets for special items, but try to find yourself a good Asian market and save lots of money.

    2. Three bucks/lb for ground beef is pretty good, dude. Of course, that’s by Seattle standards, which gave me a heart attack when I moved here from the northeast where the food is WAY fucking cheaper. Cheapest food I’ve ever found was in North Jersey. When my grandparents moved to CT from Jersey to be near their children they complained for months that the food was more expensive. Seattle would make my grandfather’s head explode.

      1. It’s cheaper because there’s a major port. I was shocked at how much cheaper food is here in Balmer, than it was where I moved from the midwest. However, housing prices whether rent or buy are about 300% more expensive here.

    3. At least you have a nice cost-to-bag ratio. My shopping can have $50 in 10 bags. If I still shopped in Los Angeles, those 10 bags would add an extra $1. I won’t be able to avoid it next year, though, since all of California is banning plastic bags and charging a minimum $.10/bag (paper or reusable).

  12. OT: So I read that Anita Sarkheesian was on The Colbert Report-yes it’s still on, WTF?-to talk about GamerGate. Of course, Colbert ate all her bullshit up and-in the words of Salon-‘gave GamerGate the smack-down it deserved’. I read the quote and it was some modestly humorous Colbert quote.

    I really, REALLY hope Stewart and Colbert and Maher are goaded into the GG fight by their SJW buddies. Go full bore guys. The worst that can happen is that you alienate the young, gullible masses who were basically your power base for a decade, turning them against you and losing most or all of your influence and cultural relevance. Seize the derp!

    1. Live by the derp, die by the derp.

      Or, something something two-edged derp.

    2. I am becoming increasingly annoyed with that sort of smug leftism. “We’re against violence against women, duh, and so everyone who opposes any part of our agenda must be in favor of violence against women!”

    3. Just post this pic to any comment board praising Sarkeesian and fire up the popcorn popper:

      http://www.returnofkings.com/w…..eesian.png

      1. *Snort.* The cap doesn’t add anything, though.

  13. Gotta roll with the punches dude. Wow.

    http://www.anon-way.tk

  14. You have to pass gas before you can find out whats in it.

  15. Looks like Obama’s just going to have to force doctors to treat Obamacare patients, or else they get put in a tent with an Ebola patient in New Jersey.

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