As the rollout of the Affordable Care Act aka "ObamaCare" continues to falter, the growing concern for consumers and patients will not only be the affordability of insurance plans and the difficulty in actually being able to buy one, but more importantly the ability for them to keep their doctor.
Although President Obama repeatedly made the statement during his marketing effort to promote ObamaCare that each individual would have the ability to keep their doctor, the ensuing problems with the rollout are, in fact, making that promise a myth.
Even if consumers make a wholehearted effort to find a plan that still has their doctor within the insurance company’s network, many doctors may soon decide that it is not worth the effort or the money, unfortunately.
Here are the reasons why.
1. Insurance reimbursements to doctors are dropping
Since October 1st, 2013 the enrollment members have dropped several insurance companies , including United and WellPoint, who have announced that the amount they would reimburse physicians for particular services is far less than what was previously allowed.
In fact, the reimbursement for some primary care services and diagnostic tests, such as mammograms, could be so low that it would be unsustainable for certain specialties to continue to deliver profitable care.
The insurance companies have limited choice in terms of sustaining their own profits with the original promise of new enrollees, especially young healthy enrollees coming through the market places, which could now be significantly delayed or never happen at all.
In order to stay profitable and still endure the responsibility of covering dependents until the age of 26, and those with pre-existing conditions, these costs have now been deferred to the doctor in terms of decreased reimbursement.
2. A rapid rise in Medicaid enrollment
Over the last seven weeks not only has the enrollment in the federal market places been under-target but, interestingly enough, a large percentage of those who did sign up for care did so for Medicaid.
Traditionally, reimbursements to doctors under Medicaid has been far less than those in the employer-sponsored and individual markets.
As a result, many doctors will see the shift in their new-patient pool lean towards more indigent patients who are on Medicaid, and who also likely have more chronic illnesses that will require more care.
Based on this shift, doctors again may find it unsustainable to take on a higher volume of patients at lower reimbursement and still be able to provide affordable quality care.
3. Narrow networks could exclude doctors
While the jury is not out in terms of the complete outcome, many insurance companies are taking a state-by-state approach in assessing how broad their network of doctors should be based on the number of enrollees in a given exchange.
If the enrollment numbers are as low as they have been thus far, then insurance companies don’t necessarily have to provide a broad network of physicians and can maintain a very narrow choice for consumers, which seems to be the trend.
Doctors do not necessarily have to agree to the lower rates that an insurance company proposes in any given network, and they may have the ability to, in fact, opt out. The technological obstacles for getting new enrollees into the marketplace has impeded the number of people who might be able to get into the system, that will, in turn, keep networks fairly narrow for the time being.
4. A two-tiered system of physician access
The way the system is unfolding is that those who remain in employer-sponsored healthcare could potentially have access to a broader-slate of physicians, as well as services. This is somewhat ironic in that the goal of ObamaCare was to obviously provide access to those individuals who didn’t have it.
Yet, the dynamics of the rollout may very well create a two-tiered system where sicker people who are buying insurance through the marketplaces with higher premiums could, in fact, find it more difficult to get access to the doctors and services they require .
While the challenges to Healthcare.gov seem to be the highlight of the problems with ObamaCare, the more serious issues really revolve around the dynamics of how insurance companies and healthcare professionals are responding to the changing demographic in numbers of those trying to access the system.
History tells us that anticipating the ultimate outcome is far more complicated than what has been sold to the American public.
Dr. Sreedhar Potarazu is an acclaimed ophthalmologist and entrepreneur who has been recognized as an international visionary in the business of medicine and health information technology. He is the founder of VitalSpring Technologies Inc., a privately held enterprise software company focused on providing employers with applications to empower them to become more sophisticated purchasers of health care. Dr. Potarazu is the founder and chairman of WellZone, a social platform for driving consumer engagement in health.