With all the controversy surrounding the implementation of the Affordable Care Act (aka Obamacare) and the failed rollout of its multimillion-dollar web site, not to even consider the millions of individuals losing their current insurance coverage, one might think that things could not get much worse. This writer would beg to differ. There is a storm on the horizon that few have mentioned or given any serious amount of ink. What I refer to is the carnage that is about to descend on the healthcare industry as a whole. It is sure to affect every single provider, whether it be hospital, physician or employees thereof. This great untamed and unrestrained beast will rear its ugly head in real time on January 1, 2014, and the results will be brutal.
You can call me a reactionary, alarmist, right wing nut or any other term used to describe those who would dare to challenge the utopian healthcare scheme, but regardless of any name-calling or attempts to minimize and discredit any truth-sayers, the outcome will not change. Though this writer does not possess the title of expert or leading authority, 35 years of experience in healthcare would tell most realistic practitioners that we are about to hit the wall.
Has anyone other than me noticed that all the empty suits and talking heads started out explaining healthcare reform in the financial sense? “Something had to be done about the spiraling medical cost”, they said. However, it has now become an issue that is not about money but about helping provide everyone with the same overpriced medical services that they once railed against for hours on end! Now, the solution would seem to be to overload the system with clients who have a limited choice of insurance and then blame the hospitals and physicians, when it all fails, for being inefficient.
At this point you might ask, “What do you mean by limited choice of insurance?” It is in all likeliness your current insurance would be accepted in any healthcare facility in your state. However, when you are forced into the ACA exchanges, things could change. According to a report published by Watchdog.org, the Cleveland Clinic accepts dozens of insurance plans if you buy your own but only accepts one ACA offering: Medical Mutual of Ohio. This is certainly not due to the lack of other plans being offered. They also reveal that both Ohio and California have a dozen or more insurance companies on their exchanges, yet two of these states’ premier hospitals — Cleveland Clinic and Cedars-Sinai Medical Center — have only one company in their respective networks.
Insurance companies are being very cautious about entering the exchange, largely due to the uncertainty of consumer participation. If the exchanges become overrun or are primarily composed of high-use clients, especially those who are noncompliant where medication and lifestyle changes are concerned, this could lead to considerable losses for insurers. This has resulted in insurers having to limit their offerings in order to maintain their premiums. (Wow! Who could have seen that coming?)
So far there have been a disproportionate number of clients who have signed up for Medicaid versus those signing up for private insurance. Even though, for the first couple of years, Medicaid is supposed to pay at the same rate as Medicare; this is going to be of little comfort to hospitals and medical practices, because Medicare reimbursement is already less than optimal in comparison to private insurance, and what physician or hospital can make plans for expansion or the purchase of new equipment based on a 2-year projection of receipts? This would be especially true if these reimbursements are almost guaranteed to go down.
This can create a real problem for consumers as well. In many cases the exchanges fail to provide the names of hospitals and physicians who are part of their exchanges. This could lead to some unfortunate financial outcomes for an unsuspecting patient who has just been informed that the physician or facility he or she uses is out-of-network.
As we have seen here in Tennessee, many small local governments will have to look for additional sources of revenue in order to comply with the ACA. This is true in the Upper Cumberland region of the state where property owners are expected to pay in the form of increased taxes. Tennessee Watchdog.org reports that local governments are being forced in some cases to curtail their contributions to nonprofits, which include such entities as Children’s Advocacy Center, Family in Crisis and local food banks. We all know that property owners are looking forward to paying additional taxes because as a county commissioner once told me, “If you are privileged enough to own property you should be glad to pay taxes.” Here I was thinking that it was years of hard work that had led to my owning property, and in an instant I learned that it had just dropped into my lap and that I should be glad to pay my share (and of course everyone else’s share if they don’t happen to be as privileged as I am).
While early supporters of the Affordable Care Act could not have foreseen trouble, reports of fraud already are emerging in Tennessee. Tennessee Watchdog.org reports attempt at fraud abound.
Scam artists, for example, are making calls claiming they need Social Security numbers to sign people up for a new Obamacare insurance card, according to a statement from the Tennessee Department of Commerce and Insurance.
“We’ve been made aware of one scam, in particular,” said TDCI spokeswoman Kate Abernathy.
“One of our navigator agencies let us know that there was an individual calling people saying that he or she could have walked him through the application process for $100 for a navigator certified application counselor service, but that information is completely incorrect. This is a free service that is supposed to remain free.”
TDCI implemented registration requirements and criminal background checks on people who serve as Obamacare navigators or certified Obamacare application counselors in Tennessee. These people are handling personal medical and financial information of prospective clients.
However, many mainstream media outlets like the Washington Post have been critical of Tennessee and other states who have implemented such requirements.
“There is a very palpable concern that anti-Obamacare state government people will find ways to gum up the works,” the Post quoted Leonardo Cuello, director of health reform for the National Health Law Program, as saying.
Here is what my many years of experience tell me: emergency rooms will become even more overcrowded as those who seek to employ their new coverage find that they are unable to find a physician who is willing to take new patients or patients who are covered by Medicaid. Additionally, there is the simple fact that there are not enough doctors to go around. The waiting period to see a physician will probably get much longer. Some of the leading deliverers in patient care will choose not to participate in plans that they deem to be unprofitable. But, just in case you remain skeptical I present a study that was conducted by JAMA (Journal of the American Medical Association) for your consideration.Bottom of Form
In an article published in the Journal of the American Medical Association they found that Medicaid patients were three times more likely than the uninsured and seven times more likely than the privately insured to use an emergency room for conditions that could have been taken care of with primary care. The summary reads as stated below:
Our findings suggest that increased enrollments in Medicaid between 1999 and 2007 have had substantial effects on ED volume and crowding, and that at least part of this may reflect limited access to primary care services for Medicaid enrollees. A deeper examination of the differential access to primary care by insurance type is needed to better understand health care utilization patterns by patients with Medicaid, and to develop more effective strategies for reducing pressure on the safety net.
This study was published in August of 2010. What would any rational person think would happen when the system is faced with millions of newly insured Medicaid patients?
The Golden Goose has laid a giant lead egg and it is hanging round the neck of every liberal incumbent in Washington. Nice work, the people will see you in 2014.