With people actually becoming enrolled in health insurance due to the Affordable Care Act, we have further evidence that the Republican scare stories are not coming true. There are no death panels. The government has not taken over health care. Enrollment in plans sold through the exchanges have met earlier projections despite the initial problems with the computer system. While it is too early for final numbers, it appears that the number of people who do not receive insurance due to failing to pay premiums will be lower than earlier projections. Now we have additional data debunking claims that physicians would not accept patients enrolled through the exchanges, there would be doctor shortages, and long waits for medical services.
The claims from Republicans that doctors would not accept patients enrolled under Obamacare were never taken seriously by those who understand how the Affordable Care Act works. Despite Republican misinformation, Obamacare is not a separate government health care plan. People obtaining coverage through the exchanges purchase private insurance which doctors would find indistinguishable from anyone else with private insurance. There is not a big red stamp saying “Obamacare” on their insurance cards. If they are to accept patients based upon coverage, medical practices give preference to patients with private insurance as it pays significantly more than government programs, and there are less collections problems compared to the uninsured.
The Journal of the American Medical Association published a study in which people called physician offices to see if they would be able to obtain an appointment. Kaiser Health News summarized the results:
Researchers posing as nonelderly adult patients made nearly 13,000 calls to primary care practices across Pennsylvania, New Jersey and eight other states between fall 2012 and spring of last year.
What they found may provide some comfort amid growing concerns of doctor shortages, especially as more people gain coverage through the Affordable Care Act, potentially straining the health system.
Dr. Karin Rhodes, from the University of Pennsylvania and a lead author on the study published this week in JAMA Internal Medicine, says when researchers said they had insurance, they were able to make an appointment about 85 percent of the time — on the first try, no less.
“Capacity exists. I think this is a very optimistic message,” Rhodes says, adding that researchers were usually able to get scheduled within a week. The median wait in Massachusetts was about two weeks.
Medicaid pays significantly less, often less than a third of what private insurance plans pay for physician services and it would be expected that fewer physicians would accept new Medicaid patients. As fewer doctors accept Medicaid patients, and those who do only accept a limited number, only sixty percent accept of researchers identifying themselves as Medicaid patients, as opposed to 85 percent saying they have private insurance, were accepted on the first call. As is currently the case withe Medicaid patients, I would expect that those in the expanded Medicaid programs will have to make multiple calls to find physicians willing to accept them and/or go to clinics which receive higher reimbursement than private physician practices.
To attempt to improve access for those with Medicaid, including those in the expanded Medicaid program, the Affordable Care Act does increase reimbursement for primary care services to Medicare levels for Medicaid patients for two years, and there is talk of extending this period. While Medicare also pays less than private insurance, the payment is more reasonable and most doctors will accept Medicare, while Medicaid payment is often insufficient to meet overhead in private practice without the temporary increase.
In other health care news today, The Los Angeles Times reports that the number of people covered under insurance from their employers has increased under the Affordable Care Act (contradicting further Republican claims):
In addition to gains in insurance coverage as a direct result of the Affordable Care Act, the number of Americans covered by employer-provided insurance also has increased in the last year, according to newly released data from the Rand Corp.
As previously reported by my colleague Noam N. Levey, Rand estimated that the number of Americans with health insurance rose by about 9.3 million as of mid-March. The group’s researchers note that the number probably has increased as their survey missed much of the final surge of enrollments in the online marketplaces created by the healthcare law, also known as Obamacare.
The share of Americans aged 18 to 64 who lack coverage dropped from 20.5% to 15.8% by Rand’s calculations.
The 9.3-million increase in coverage, which takes into account people who lost coverage, includes people who enrolled in plans on the marketplaces, those who bought a plan directly from an insurer and those who became eligible for Medicaid. About half the states have expanded Medicaid under the law’s provisions.
But the full Rand report, released Tuesday, notes that the figure also includes a significant increase in employer coverage. That increase contradicts predictions made by both opponents of the law and some of its supporters who had expected employer coverage to drop when the 2010 healthcare law took effect.
Joan McCarter wrote more on the increase in the number of newly insured. Adrianna McIntyre also looked at the recent RAND study, including how some conservatives try to play games with numbers they don’t like.
The New York Times reports that, as would be expected, sicker people enrolled earlier. It is not surprising that those with medical problems, many of whom were denied coverage due to pre-existing conditions in the past, would be more motivated to obtain health care coverage as soon as offered while healthier people were more likely to procrastinate until the March surge. The early enrollment of those with serious medical problems is another indication of the value of the Affordable Care Act.
There is also considerable attention being paid today to reports from Medicare regarding payment to physicians. In some cases, those receiving the highest payments might be those with the largest volume of Medicare patients doing high-cost procedures, while in other cases there may be indications of Medicare fraud. Medicare has already been placing those receiving the highest reimbursement under increased scrutiny.
Cross posted at The Moderate Voice