Remember when you learned arithmetic in elementary school and having the right answer wasn’t enough, because the teacher demanded that you tell her not only the right answer, but also how you figured it out?
They should try that in Washington. Because when it comes to ObamaCare, the math is all wrong. The numbers don’t add up. And somebody had better solve this equation before the whole system comes crashing down.
The sad truth about the curiously named Affordable Care Act is:
· Insurance premiums are rising;
The Affordable Care Act’s goal – to provide quality health care at an affordable price to all Americans – is a noble one. But as things stand now, it is not the sum of all its parts. It just doesn’t add up.
· Hospitals are having trouble staying solvent;
· Emergency room visits are up, not down;
· “Narrow networks” are restricting the number of quality physicians.
Factor in that the Supreme Court could decide this month that states do not have to accept federal subsidies for ObamaCare patients who need them, and things could get exponentially worse in a heartbeat.
Here’s the sorry math. You could say it’s elementary.
1. Premiums are rising.
The way things are going, the Affordable Care Act may have to be renamed the “Care Act,” because it won’t be affordable for long. Insurance companies are finally discovering the true cost of care based on the needs of people who have bought coverage. This data wasn’t available when the program began, and now that it is, the insurers are asking for large hikes in their rates.
The rates were initially based on the notion that young and healthy people would sign up for health insurance, and that their participation would balance out the higher costs of older, sicker people. But that hasn’t happened. Many of them are deciding they’d rather pay a small tax penalty and go without health care than pay a higher amount for a plan they feel they don’t need right now. It’s a gamble, but they’re willing to take it, and it means the insurance companies have to raise their rates to accommodate subscribers who, on average, are older and sicker than they anticipated. But when the rates go up, the penalty becomes an even more attractive alternative for the young and healthy. Add the fact that federal subsidies to states that haven't built their own health care exchanges have kept premiums in check, and it’s clear that everything could spin out of control if the Supreme Court pulls the subsidies out of the equation.
2. Hospitals are having trouble staying solvent
As reported last week in the Wall Street Journal, a recent study by Moody’s Investors Service showed that nonprofit hospitals in the states that expanded Medicaid aren't seeing fewer unpaid bills and more paying customers, which they expected. This refutes “a narrative out there that Medicaid expansion has lowered bad debt and that is driving [financial] improvements at hospitals,” Moody’s analyst Daniel Steingart said.
You can’t provide quality care if you can’t stay in business, and many hospitals are finding that the cost of accommodating an expanded pool of Medicaid patients does not make up for the decrease in reimbursements they are receiving under ObamaCare. Sure, health care is more affordable. But it won’t make a difference if there’s no hospital to provide it.
3. Emergency Room visits are rising
The low reimbursements that accompanied the expansion of Medicaid have resulted in a shortage of primary care doctors, and that has pushed more people to visit the ER as their primary source of care.
"America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” says Dr. Michael Gerardi, president of the American College of Emergency Physicians. "Just because people have health insurance does not mean they have access to timely medical care.”
ObamaCare proponents expected that when more people could afford care, they would go to physicians’ offices instead of the ER. It hasn’t turned out that way.
4. Narrow Networks Restrict the Number of Quality Physicians
President Obama famously announced in 2009 that under the Affordable Care Act, “If you like your doctor, you can keep your doctor.” He should have added, “maybe.” In order to keep their costs down, health insurance companies are increasingly offering “narrow network” plans that allow subscribers to visit only certain doctors and hospitals. Subscribers have had to sign up for plans that cover visits to some of their physicians, but not all of them.
This came about because the insurers did the math, and it added up to something the president promised wouldn’t happen: a limited pool of physicians and medical centers – not an improvement in care – in order to keep the insurers’ costs in check.
The Affordable Care Act’s goal – to provide quality health care at an affordable price to all Americans – is a noble one. But as things stand now, it is not the sum of all its parts. It just doesn’t add up. And like a car heading too fast toward a sharp curve on a wet road, it’s going to spin out of control unless someone hits the brakes, and fast.
Noble goals deserve noble outcomes. But right now, the patient known as ObamaCare is on life support.
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.