Thursday, November 20, 2014

The Effects of Obamacare and What has Changed

When the Affordable Care Act, more popularly known as Obamacare, was passed in Congress, many thought the problems of a large uninsured portion of the population would be solved. Unfortunately, theory does not always translate into practice. Although more people today are insured, problems with reimbursement rates and disgruntled citizens who refuse to apply, still present obstacles for doctors and hospitals. 

More people are insured, which means less people in emergency rooms


Before, many would simply wait until they were too sick to work, and then go to the ER. Unfortunately, that usually meant they would end up being hospitalized. But Dr. Ira Potter, who practices in one of the poorest regions of Kentucky, told the Louisville Courier-Journal that now his low-income patients are receiving subsidies for insurance, or have been moved to Medicaid. With help from the government, he said, they can now afford to pay for a physician.

Reimbursements are low—meaning many doctors won’t take Obamacare


Dr. Bob Russo, radiologist and president of the Connecticut State Medical Society, told National Public Radio that low rates and administrative headaches that come along with the program could make it a “financial loser”. He pointed out that if doctors can’t be convinced that they're not losing money doing their job, there will be problems. “And they haven't been able to convince people of that," he said.

The problem is not just in Connecticut; numerous companies have cut their reimbursement rates for plans that fall under Obamacare. When Blue Shield of California was designing the new health plans it would offer under Obamacare, the insurer asked doctors and hospitals in its network to accept rates as much as 30 percent lower than what it previously paid.

Only 60 percent of the doctors and 75 of the hospitals that participate in the Blue Shield of California’s group plans chose to participate in plans purchased through the state’s insurance exchange. Some of the state’s most prestigious hospitals, including Cedars-Sinai Medical Center in Los Angeles and University of California medical centers, dropped out altogether.

Hospital charity care is being tied to Obamacare signups


To a number of people, Obamacare carries a whiff of socialism. The end result is that for many hospitals in rural areas, many will still go uninsured and risk getting sick despite the fact that they would be eligible for insurance coverage. William Parsons, 40, told a reporter that he has no health insurance and doesn't intend to apply. "Goin' to the doctor just isn't something I like to do. ... No good comes of going."

Parsons is not an exception. Many hospitals are now reevaluating their charity care policies and demanding that those who would normally be eligible at least attempt to sign up for subsidized insurance. According to a high risk pregnancy specialist, Dr. Gilbert Webb, even insurance for one time procedures like pregnancies are affected. As an example, Southern New Hampshire Medical Center in Nashua now states that applicants who do not purchase federally-mandated health insurance when they are eligible to do so will not receive charitable care.

Katherine Arbuckle, senior vice president and chief financial officer at Ascension Health based in St. Louis, told the Washington Post that the question is whether a patient can pay or simply doesn’t want to. “How do you treat those who decline [coverage]? Do they get free services when others have paid?” she asked.

In reality, Obamacare is still in the shakedown phase. In order to ensure that the program is as effective as possible, it needs to be tweaked in certain areas in order to ensure that the most vulnerable populations are covered. Combined with better education about the program, Obamacare should prove to be more successful in years to come.

Information Credit: Vitals

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