11/25/2013 @ 4:53PM
When Will The Government Start Forcing Doctors To See Obamacare Patients?
The Supreme Court Trauma Center
Patient access to doctors is approaching a perfect storm of decreased physician supply, more demand for medical care—especially after Obamacare kicks in—and doctors increasingly refusing to see low-paying Medicare or Medicaid patients. If the “promise” of Obamacare’s access to health care is to be kept, government will eventually have to force doctors to accept Obamacare-covered patients. Because such a step would represent such a radical departure from physician autonomy, you might call it the “medical nuclear option.” [See a related piece on Medicare and Medicaid reimbursement cuts here.]
To begin with, the U.S. is already facing a doctor shortage. The Association of American Medical Colleges warns that the nation will face a shortage of 91,500 physicians by 2020. With respect to family physicians, a study published in the Annals of Family Medicine predicted a primary care physician shortage of 52,000 by 2025.
There are several reasons for the shortages. An aging population needs more medical care. Doctors are retiring in large numbers, fed up with the bureaucratic challenges and red tape imposed by government and health insurance. Plus, federal funds for training doctors can lead to shortages in some areas of the country.
Second, the implementation of Obamacare will likely exacerbate the doctor shortage. People who have been uninsured for a while who then get coverage tend to use significantly more health care for the first few years. If Obamacare results in an extra 30 million-plus people getting coverage—though at this point it isn’t clear whether, given the cancelations, higher premiums and the young and healthy potentially not enrolling, more people will ultimately have coverage—the demand for doctors will grow significantly, even as the relative number of doctors declines.
Third, a growing number of doctors are refusing to take new Medicaid or Medicare patients, and there is every reason to think the same will happen under Obamacare.
The Centers for Medicare and Medicaid Services (CMS) recently reported that 9,500 doctors who had previously accepted Medicare patients refused to do so in 2012. And the American Academy of Family Physicians says that doctors willing to accept new Medicare patients declined from 83 percent to 81 percent (most will continue to see Medicare patients they currently treat).
With respect to Medicaid, a study in the health policy journal Health Affairs found that 33 percent of primary care physicians weren’t accepting new Medicaid patients. But that figure can vary significantly by state. The Texas Medical Association says that only about a third of Texas doctors are willing to take all new Medicaid patients.
Why are doctors increasingly rejecting Medicare and Medicaid patients? Low government reimbursement rates. And that is where Obamacare comes in. News stories are already emerging that doctors will be paid significantly less for treating Obamacare patients than they would make from non-Obamacare private insurance, and perhaps even Medicare.
The New York Post recently reported on a very troubling survey from the New York State Medical Society, which found that 44 percent of New York doctors are not participating in Obamacare. Worse yet, three-fourths of those who are participating are being forced to because of existing insurance contracts. Only one-forth of those participating volunteered to do so.
One reason Obamacare is cutting reimbursement levels is to keep premiums as low as possible in a futile effort to reduce the premium “sticker shock” that has already hit the country. As Kaiser Health News writes, “Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable.” And we haven’t even hit the “death spiral” of exploding premiums yet.
If Obamacare is not repealed and too many doctors refuse to take Obamacare coverage, the government will eventually have to find some way to force doctors to participate, but how? As long as Republicans control at least one house of Congress (or eventually the White House), it’s very unlikely Congress would go along with a forced-participation law.
Could Health and Human Services (HHS) Secretary Kathleen Sebelius use regulations or financial incentives to get physicians to participate? As one example, Obamacare included $230 million to increase the number of medical residents, as well as physician assistants and nurse practitioners. Those or future grants could come with Obamacare-participation strings attached.
States could also play a role in forced participation. States license physicians and oversee insurance contracts. Many Democratically controlled states are just as invested in the success of Obamacare as the president. Thus a blue-state governor and state legislature could mandate all of the state’s doctors accept Obamacare as a condition of practicing in the state, or require doctors accepting private insurance to accept Obamacare coverage also. It may be the only way to ensure Obama’s promise that if you like your doctor you can keep your doctor—or at least “some doctor.”
Invoking this medical nuclear option would surely exacerbate the doctor-shortage problem, as those unwilling to be shackled by the government retire or perhaps try to switch to a cash-only basis. But HHS and the states are already gearing up to fill some of that gap with physician assistants and nurse practitioners.
Democrats at both the federal and state levels are trying and make one of the country’s biggest policy disasters work. They have already committed trillions of taxpayer dollars to get their government-controlled health care system up and running (sort of); it is very unlikely that they will let doctors’ unwillingness to take Obamacare coverage stand in their way.