Changing Insurance or Physicians Under The Affordable Care Act

We are seeing the hypocrisy of conservatives once again regarding the Affordable Care Act. While this was being considered in Congress, Republicans thought they could win debating points by demanding that federal employees be changed from their current system to receiving insurance through the exchanges. The Democrats called their bluff as, in reality, the idea behind  Obamacare  is to give  all Americans access to insurance coverage comparable to what federal employees had.

Of course when you have a good thing going, it is to be expected that you anyone would be wary of any change. It comes as no surprise that virtually all federal workers polled would prefer not to change their current system. If I was in their position, I certainly would say to maintain the status quo as opposed to risking any change. Conservatives sites are now trying to use this as an argument against the Affordable Care Act, despite the fact that this is an aspect of the law pushed by Republicans. This is also in no way evidence that the coverage will be any worse than the current coverage under the Federal Employees Health Benefit Program. It would be more interesting to see if a few years for now federal employees have seen a deterioration in their health care coverage.

Of course the effects on federal employees is a minor portion of the law, and again one pushed by Republicans. The important change brought about by the Affordable Care Act is that those purchasing insurance in the individual market, who often do not currently have any access to affordable care, will be able to select from a variety of choices just as federal employees have been able to.

Federal employees very will may wind up with the same insurance plan they have now, should they desire to, provided that their current insurance company provides coverage through the exchange. Some federal employees might have to change insurance plans, but they should still be able to get comparable coverage, and in most cases continue to see their current doctor. Some might wind up changing to a plan which their doctor doesn’t participate in and have to change doctors. This has led back to the controversy over whether individuals will be able to keep their own doctor under Obamacare.

Obama made a simple response to this controversy which is generally true but there are exceptions when saying that people will be able to keep their current doctor under the Affordable Care Act. This is not one hundred percent true as no plan, and certainly not the status quo, could ever guarantee this short of a totally government run plan. The underlying question at the time was whether Obama was proposing a government-run plan which would tell people which doctors they could see. In this context Obama was correct. The Affordable Care Act provides individuals with choices–more choices than they have now–and makes it easier for people to continue to see their own doctor. Nothing in the plan mandates that anyone change doctors.

On the other hand, this could not be guaranteed in every case as people change insurance plans and doctors are free to decide which plans we participate in. Every January I lose a number of patients because they have changed to plans I do not accept. In some cases this is due to a patient making a change without realizing it, and sometimes they can still reverse the change. More often it is due to their employer changing insurance coverage and the employee has no choice. Sometimes it is due to changing jobs. In addition, it is not that uncommon for patients to stop seeing me because they lose their job and lose insurance coverage.

There are a variety of reasons why physicians might not accept a plan. Sometimes it is because of poor payment. Other times it is because of the paperwork involved. With some plans there is no issue of being considered part of the plan, or the simple act of seeing a patient in a plan leads to the plan considering me to be participating. In other cases paperwork needs to be done. When I am often drowning in paperwork, and have more people than I can handle requesting to be new patients, I might not bother to fill out an application for a plan which doesn’t cover a significant number of people in the area.

The Affordable Care Act cannot guarantee that someone can always see their current physician should they change to a plan which their physician does not accept. It will decrease the risk of being forced to change physicians by making it less likely that individuals will lose their insurance coverage, by reducing the connection between coverage and current employer, and by providing more choices in insurance plans. Individuals should always check with their physician’s office before changing insurance plans if concerned about whether they might have to change doctors.

This does not mean that everything will be perfect under the Affordable Care Act. As I have pointed out several times before, adjustments in a law of this size are still needed, and in the past would have occurred if not for Congressional Republicans not wanting to bother with actual legislation, while having plenty of time to vote forty times to revoke the law. One problem, which might influence access to care is that people who receive subsidized care through the exchanges have a three month grace period before they are removed from a plan, but insurance companies will only be required to pay claims for the first month. If physicians wind up providing a significant amount of unreimbursed care due to this problem, many might be reluctant to take such patients. On the other hand, there is a push to improve computerized access to up to date insurance information. This problem could be resolved if we have easy access to information as to whether a patient falls into this category, allowing physicians to request payment up front if they have not paid their premiums. This also might provide incentive for these individuals to get their premiums paid.