Obamacare: Enrollees Face Unhappy Surprises, Doctors Explain 'Access Shock'

Posted: Aug 04, 2014 1:25 PM

As government watchdogs pound the White House's incompetence and negligence over the implementation and administration of Obamacare, the law has slumped to a new low in the (generally Obamacare-friendly) Kaiser Family Foundation national survey released last week. Administration officials are warning consumers that November's open enrollment period won't to go smoothly, predicting "bumps" and higher premiums. The system is still disjointed because, in spite of nearly $850 million already spent on Healthcare.gov, the hub's "back end" still isn't built -- and isn't expected to be functional until some time in 2015. This glaring flaw has created data discrepancy headaches left and right, and has opened the door for fraud. Sticker shock and confusion have simultaneously led to some "attrition" among enrollees who purchased plans, but have ceased paying for coverage. And all of this against a backdrop of steadily increasing costs for average people who were assured that Obamacare would save their family thousands per year. The New York Times catches up with some of the law's freshly signed-up consumers and discovers that some of the law's "beneficiaries" aren't exactly thrilled with their benefits:

Last week, Salwa Shabazz arrived at the office of a public health network here with a bag full of paperwork about her new health insurance — and an unhappy look on her face. She had chosen her plan by phone in March, speaking to a customer service representative at the federal insurance marketplace. Now she had problems and questions, so many questions. “I’ve had one doctor appointment since I got this insurance, and I had to pay $60,” Ms. Shabazz told Daniel Flynn, a counselor with the health network, the Health Federation of Philadelphia. “I don’t have $60.” Mr. Flynn spent almost two hours going over her Independence Blue Cross plan, which he explained had a “very complicated” network that grouped doctors and hospitals into three tiers. Ms. Shabazz, who has epilepsy, had not understood when she chose the plan that her doctors were in the most expensive tier. “None of that was explained when I signed up,” she said. “This is the first I’m hearing it.” Many people who signed up for private coverage through the new marketplaces had never had health insurance, and even the basics — like what a premium is and why getting a primary care doctor is better than relying on the emergency room — are beyond their experience. Others have a sense of how insurance works but find the details of the marketplace plans confusing, especially if they signed up without the help of someone who understood them.

Some Obamacare recipients are discovering that coverage isn't as "affordable" as they'd hoped -- and certainly not free. The story goes on to explain that Ms. Shabazz ended up leaving her job as her health problems deteriorated, dropping her into "coverage gap" territory; she had earned too much this year to qualify for Medicaid (liberals will blame this on her state's decision against expanding the program at substantial cost, ignoring Medicaid's proven failures), but too little to continue to qualify for ongoing generous taxpayer subsidies. Those subsidies made the plan she selected appear to be within reach financially, but that was before she found out about out-of-pocket costs. The story concludes with a health adviser recommending that Shabazz cancel her Obamacare plan, reducing her to tears. As President Obama said last November, "what we're discovering is that insurance is complicated to buy." Recent polling has shown that a large majority of the newly insured are satisfied with their coverage, but many are struggling to pay for it. People who were thrown off of existing plans (thus exposing an "appalling" presidential lie, to quote Barney Frank, who nevertheless voted for the law) are significantly less pleased with their new coverage than their previously-uninsured counterparts. Multiple polls have shown that Obamacare has directly hurt roughly twice as many Americans as it's helped. One of the law's consequences is "access shock," a phenomenon we've written about a lot. This problem generally arises from people discovering that their doctors are not covered by their new plans' networks, many of which are dramatically narrower than they'd expected. Read this profile of several Connecticut doctors whose experiences with Obamacare illustrate the considerations that are fueling this problem:

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates. That's not something he's willing to put up with. "I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates. You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on," he says. Three insurers offered plans on Connecticut's ACA marketplace in 2014 and Gerard is only accepting one. He won't say which, but he will say it pays the highest rate...Gerard's decision to reject two plans is something officials in Connecticut are concerned about. If reimbursement rates to doctors stays low in Obamacare plans, more doctors could reject those plans. And that could mean that people will get access to insurance, but they may not get access to a lot of doctors.

"Access shock," defined. Other doctors concur:

Lalime says he also thinks low reimbursement rates are forcing some doctors to decide against accepting insurance under the Affordable Care Act. Dr. Bob Russo is sure of it. He's a radiologist and he's also the president-elect of the Connecticut State Medical Society. He says that the low rates and administrative burdens that come along with the ACA could make it a financial loser. "You get what you pay for," he says. "If you can't convince [doctors] that they're not losing money doing their job, it's a problem. And they haven't been able to convince people of that." He, like Counihan, worries about creating a tiered health care system. Think about Medicaid, he says. Before a recent rise in rates, it paid doctors even less than Medicare, so many stopped accepting Medicaid patients.

Now, remember Ms. Shabazz? Even if her state had expanded Medicaid, and even if you ignore the program's bad outcomes (linked above), she would likely bump up against all-too-familiar struggle for Medicaid recipients: Major, maddening problems finding doctors willing to accept new patients within that program. Coverage does not equal care. Before you go, click through to this editorial exposing taxpayer-funded raises being doled out to Massachusetts' Obamacare exchange administrators. The state's marketplace failed miserably, and has been entirely scrapped, flushing hundreds of millions of public dollars down the tubes. Those responsible for this breathtaking ineptitude are being rewarded with compensation bumps, and taxpayers are footing the bill.

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