Nov 6, 2013
Amid the number-crunching of premium costs and enrollment demographics on the ObamaCare exchanges, a critical component has been missing in too many calculations: doctors.
Even if Texas' federally-run exchange manages to reel in enough participants to keep it financially afloat, it's unclear if there will be enough participating physicians to provide adequate access to care. A recent survey of doctors in New York revealed that 44 percent were not participating in the Affordable Care Act (ACA), while only 23 percent plan to accept patients with plans from the exchanges. One reason these doctors are reluctant to participate is that 77 percent of those surveyed have yet to receive a fee schedule and do not know what they will be paid under the new exchange plans.
They have good reason to be worried. The Independent Payment Advisory Board (IPAB), created by ObamaCare, is meant to find savings in the Medicare program to help pay for subsidies on the exchanges, but the only mechanism to control spending available to the IPAB is to cut Medicare reimbursement rates for physicians.
But uncertainty about pay is not the only reason physicians are reluctant to participate in the new ObamaCare system. Doctors undergo at least a decade of schooling and residency to practice their profession, yet the ACA imposes a host of new and onerous regulations, such as restricting where physicians can refer Medicare patients for specialist care.
In response to a recent visit to Texas by Health and Human Services Secretary Kathleen Sebelius, Texas Attorney General Greg Abbott noted that ObamaCare allows the government to "[step]-in between the doctor-patient relationship," replacing physician's judgment with government mandates.
That's a problem because the effect of burdensome regulations is to discourage young people from joining the medical profession at a time when physician shortages loom. The Association of American Colleges has estimated that by 2020, the country will need 91,500 more physicians. That's in additional to the currently estimated nationwide shortage of 20,000.
With dwindling supply and skyrocketing demand from millions of newly-insured or Medicaid-enrolled individuals as a result of the ACA, coverage may improve in terms of enrollment, but to what end? Coverage without access to care is like having a driver's license without access to a vehicle.
In an environment of increasing government control, expect doctors to find ways to practice outside ObamaCare, such as concierge medicine, in which the patient pays an annual fee for access to a primary care physician. As Dr. Bradley Allen recently wrote in the Wall Street Journal, these doctors, "work with a base of 300 to 600 patients instead of the 3,000 to 5,000 typical in the ACA era." Patients who can afford such an arrangement benefit from receiving care as their doctor sees fit, "instead of as if the patient is on an assembly line with care directed on orders from Washington.""