July 14, 2013: A doctor in Altamont, Tenn., examines a patient at a rural clinic.
Those signing up for private health care coverage on the ObamaCare exchanges may be in for an unpleasant surprise — they’ll have insurance, but they might have trouble getting the doctor to see them.
As hundreds of thousands enroll for coverage beginning Jan. 1, analysts are warning that the plans are likely to give them access to fewer doctors and hospitals. So much so, they warn, that the system could begin to resemble Medicaid, the health care program for low-income Americans.
“Indeed, I think this will eventually be like Medicaid,” said Merrill Matthews, director of the Council for Affordable Health Insurance.
Matthews said the only way many insurers are going to be able to control costs is by “simply clamping down on the amount they are willing to pay.”
Just as with Medicaid, analysts warn that if payments get too low, many doctors might start refusing to see patients. That will leave more and more patients jockeying to see fewer and fewer doctors.
They emphasize, then, that having health insurance won’t necessarily translate into access to health care.
“About half of the physicians in many communities refuse to take Medicaid patients because the payment system is just too low,” said James Capretta, of the Ethics and Public Policy Center.
Doug Holtz-Eakin, former director of the Congressional Budget Office, suggested some of the plans on the exchanges are going in the same direction.
“If you look at something where you get a dollar by treating a private payer, you get about 70 cents out of Medicare for that same treatment, you get about 55 cents out of Medicaid for that,” he said.
He added: “You know, ObamCare started to look like Medicaid of the future, and in the Medicaid in the present, you can have the insurance but a doctor won’t see you.”
By the end of March, the Obama administration hopes to increase the number of people on Medicaid by 9 million, and the number in private plans by 7 million. New Medicaid enrollments so far have far outpaced enrollments in private plans on the exchanges.
But since Medicaid patients already have access to relatively few doctors, expanding that population while opening the door to lower payments for private insurance raises the prospect of rationing, as too many people chase too few doctors.
“These networks are going to be jammed with people,” Robert Laszewski, president of Health Policy and Strategy Associates, said. “Far more than they’re treating now, and I don’t doubt that we’re going to have problems with access to these doctors. There just aren’t going to be enough of them.”
For now, the Obama administration is trying to move past a year of some ups and many downs for its health care law, and encourage people to sign up during the final three months of open enrollment. President Obama said in his year-end press conference that enrollment has picked up considerably as problems with the federal exchange website have been addressed.
“The law is working: More than half a million Americans have enrolled through HealthCare.gov in the first three weeks of December alone — and 800,000 more are on track to get Medicaid through their states,” he said in an email message on Sunday.
Obama continued to stress that the law is providing health insurance to those previously unable to get it. “Now, thousands of Americans are signing up for coverage every day. That matters. It means financial security for families all across the country. It means freedom from the fear that one illness or accident might cost you everything you’ve worked so hard to build.”
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