Reimbursements under Obamacare are at bottom-dollar – they are even lower than Medicare reimbursements
By Barbara Boland
Over 214,000 doctors won’t participate in the new plans under the Affordable Care Act (ACA,) analysis of a new survey by Medical Group Management Association shows. That number of 214,524, estimated by American Action Forum, is through May 2014, but appears to be growing due to plans that force doctors to take on burdensome costs. It’s also about a quarter of thetotal number of 893,851 active professional physicians reported by the Kaiser Family Foundation.
In January, an estimated 70% of California’s physicians were not participating in Covered California plans.
Here are some of the reasons why:
1. Reimbursements under Obamacare are at bottom-dollar – they are even lower than Medicare reimbursements, which are already significantly below market rates. “It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60,” a study by the think-tank American Action Forum finds. “For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California’s Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent.”
2. Doctors are expected to take on more patients to make up for the lost revenue, but that’s not happening, because primary care doctors already have more patients than they can handle. “Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the PCPs time at lower pay,” says the study.
The study also points to two reasons that doctors might not get paid at all:
3. An MGMA study indicates that 75% of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they will get stuck with the bill.
4. HHS requires that insurers cover customers for an additional 90 days after they have stopped paying their premiums: the insurer covers the first 30 – but, it’s up to the doctor to recoup payment for the last 60 days. This is thenumber one reason providers are opting to not participate in the exchange plans. Currently, about a million people have failed to pay their premiums and had their plans canceled.
So, Obamacare is asking doctors to take on sicker patients for less money, with the risk of not getting paid at all? No wonder doctors are running from these plans!