Study: Doctors Declining to See Obamacare Patients

Published December 1, 2014

A recent study found large numbers of doctors are declining to participate in health plans offered through exchanges set up under the Affordable Care Act, raising questions about whether people buying insurance through exchanges will be able to access health care in a timely manner.

Conducted by the Medical Group Management Association (MGMA), the MGMA ACA Exchange Implementation Survey Report found 20 percent of U.S. physicians are not seeing patients who are covered by plans sold on exchanges set up by the Affordable Care Act, commonly called Obamacare. The three major reasons cited by doctors include the difficulty of obtaining coverage information, patient cost-sharing, and network limitations.

Twila Brase, president of the Citizens’ Council for Health Freedom (CCHP), said, “Due to high deductibles or narrow networks—or the physician’s refusal to get paid for doing more with less—some doctors will not be available to these new government enrollees.”

As to the differences between Medicaid and ACA plans, Brase said, “Anyone on Obamacare is in what we call ‘Medicaid for the middle class on a sliding fee scale.’ It’s not private insurance.… Both are government-controlled programs and both use health plans as contractors, except that Medicaid has little to no risk of a two-month coverage gap.”

Multiple Reasons for Declines

Doctors surveyed for the study cited several challenges in treating patients with policies from Obamacare exchanges.

Responses were anonymous, but included: “We are going to have to hire additional staff just to manage the insurance verification process,” “Identification of ACA plans has been an administrative nightmare,” and “We thought we would be able to identify ACA insurance exchange products by their insurance card, but quickly found out this isn’t so.”

High levels of patient cost-sharing are another challenge. Seventy-five percent of doctors responding reported patients with Obamacare coverage “are very or extremely likely to have high deductibles compared to patients with traditional commercial coverage.”

Doctors involved in the study also described “significant patient confusion” regarding what their plans cover, and reported patients who learn about their deductible after the fact are more likely to cancel appointments and procedures, affecting preventative measures and doctor visits.

Doctors are also concerned about network limitations, the survey found. Many practices are out of the network of Obamacare plans; 20 percent of respondents said their practice was excluded from a network they would have liked to participate in. Limited networks also make referrals to other doctors a problem.

Sally Pipes, president of the Pacific Research Institute, said, “Patients will have a harder time finding doctors to treat them, and waiting times will grow” as a result of doctors declining to accept patients covered under Obamacare. “If one cannot work because of illness, it reduces one’s contribution to the economy,” Pipes noted.

Insurance, Not Health Care

Dr. Kris Held, an eye surgeon from Texas, is one of many doctors who won’t see patients with Obamacare plans. She said one of the biggest misconceptions people have regarding Obamacare is that insurance coverage equates to health care.

“[Obamacare] fails to provide affordable health insurance and fails to provide access to actual medical care to more people but succeeds at compounding existing healthcare cost and accessibility problems and creating new ones,” Held said, describing the lack of care under Obamacare as a form of “rationing.”

Dr. Jane Hughes, a surgeon in Texas, shared similar concerns when explaining why she doesn’t accept patients with Obamacare plans. Hughes noted health care accounts for more than one-sixth of the private sector economy and said, “all of what is wrong with our current healthcare system is magnified by Obamacare.” Like other doctors, she cited inability to identify coverage, cost-sharing levels, and narrow networks as her primary concerns.

 She added, “2,700 pages of tortuous, deceptive law … is not fixable. It is like thinking you can cure metastatic cancer by just removing one or two of the biggest tumors.”

Alexander Anton ([email protected]) writes from Chicago, Illinois.