Imagine trying to get your favorite doctor into the new healthcare plan but you can’t because he won’t accept your coverage. Instead you have to find a new doctor, establish a new relationship and have him get to know your medical history. It might seem like something possible but your treatment may be affected by the lack of medical background from your new doctor. This is all because insurers are slashing payments to medical practices in many of the plans they sell through the new health-law marketplaces. And guess what the doctors are doing? They are leaving the plans.
Insurers Not Paying Their Fair Share
As an example UnitedHealth Group Inc. sent some New York City physicians contract amendments as recently as this month setting rates well below what doctors normally see from private insurance, including less than $40 for a typical office visit and about $20 for reading a mammogram. Some of United’s rates fall close to what the state Medicaid program for low-income people pays for the same services. Keep in mind that doctors invest alot of money on equipment to keep your health in tip top shape.
Doctors have long protested declining or stagnant rates from government programs such as Medicare and Medicaid, and had looked to the exchanges to usher in more privately insured patients. More physicians may leave the plans as awareness of the new low rates spread. Insurers are not out to provide you the best health but rather the most affordable to a degree. Insurers are for profit organizations and answer to shareholders. There was a statistic I remember seeing that 5% of the insured accounted for 80% of the expenses.
The 2010 Obamacare law doesn’t include any requirements for limiting physicians’ payments or restricting insurers’ arrangements with doctors. But in order to keep prices low for exchange plans, many health insurers cobbled together narrow networks of doctors who agreed to lower their fees. Some doctors just parted ways but haven’t given notice yet.
State-run Medicaid programs are being expanded in some states under the law. The program has long grappled with problems in patients’ access to services because not all doctors are willing to accept the generally low reimbursements. The worry is that a dual system could emerge for the insured, where people who get health insurance through their jobs can go to a broad slate of doctors, while those newly covered in the exchanges get fewer choices. Depending on their plan, people may be able to see an out-of-network doctor and get some level of reimbursement. But many plans on the exchanges are HMO-style closed networks.
How much leverage plans have to push down rates for physicians could depend in part on the number of consumers who sign up for coverage in the exchanges. The exchanges have gotten a slow start due in part to technical obstacles and a troubled rollout. If few people enroll in coverage, insurers may not need broad networks, but if enrollment soars, they may have to return to the negotiating table. Doctors would then be able to get more. Meanwhile, community health centers, long accustomed to treating the uninsured, are ramping up. These centers have thrived under a low doctor rate environment. But if given the choice, would you prefer your doctor or a community health care center?