J. D. Heyes
December 14, 2013
Don’t look now, America, but another very predictable consequence of Obamacare is beginning to play out.
Not only are customers losing their insurance plans – the plans Obama said they could keep – but now, insurance companies are dropping physicians from coverage plans as well.
As reported by The Wall Street Journal:
UnitedHealth Group, Inc., the nation’s largest provider of privately managed Medicare Advantage plans, has dropped thousands of doctors from its networks in recent weeks – spurring protest from lawmakers and physician groups and leaving many elderly patients unsure about whether they need to switch plans to keep seeing their doctors.
Obamacare regulations ‘driving our actions’
The paper said physicians in at least 10 states have received termination letters. Some of those letters have cited “significant changes and pressures in the health-care environment.”
In addition, the notices inform doctors that they can appeal the decision within 30 days, but that means doctors and patients won’t know for certain who is in, and who is out of, UnitedHealth’s Medicare Advantage networks before open enrollment to switch Medicare plans ends on Dec. 7.
The insurer said its provider networks change constantly, and it expects its Medicare Advantage network “to be 85 percent to 90 percent of its current size by the end of 2014.” But the company would not say how many providers are being curbed in individual states, or what criteria it is using to cut them.
Company officials say they are making their decision based on financial concerns – concerns that are being influenced solely by the mandates contained in Obamacare. Officially, they say United Healthcare is taking the action to provide more value for its customers, but that is corporate-speak for, “We’re making this move because we’ve been forced to do it.”
“That’s what’s driving our actions,” Austin Pittman, president of UnitedHealth’s networks, told WSJ. “It’s no secret that we are under substantial funding pressure from the federal government.”
While the company reported a third-quarter profit of $1.57 billion last month, its CEO, Stephen J. Hemsley, has said the outlook for next year is much more cautious, citing expected cuts in Medicare payments that are tied to the Affordable Care Act (and if you thought only Republicans “want to cut Medicare,” remember that no Republican voted for the Affordable Care Act – only Obama’s Democrats).
Medicare Advantage is a Medicare alternative. It combines hospital and physician coverage that includes prescription drugs and other benefits and perks, like gym memberships.
Since 2004, enrollment in Medicare Advantage has nearly doubled to 13 million in 2012; that represents nearly 27 percent of all Americans enrolled in Medicare.
As explained by WSJ:
The federal government pays private insurers a per-capita fee to manage the benefits. The rate is currently about 12 percent more than the average Medicare patient spends annually. The Obama administration plans to cut those extra payments to insurers by about $150 billion over the next 10 years to help pay for the health law. Some experts expect enrollment in Medicare Advantage plans to decline sharply if that occurs.
More patients for same number of doctors equals nightmare
Humana Inc., Aetna Inc. and Wellpoint Inc. are also Medicare Advantage providers. They told WSJ that they are evaluating their provider networks at the time, but physician groups say none of them appear to be reducing them to the extent that UnitedHealth is doing.
“UnitedHealth is the biggest player, with nearly three million members in Advantage plans, many of them sold under the AARP brand. The company says it had over 350,000 doctors in its Advantage provider networks,” says the paper.
That patients would have less access to physicians because of Obamacare – for one reason or another – was entirely predictable. For one, the law calls for insuring tens of millions more people but ignores the basic law of supply and demand: More patients trying to access the same number of doctors means more waiting time, less access and greater dissatisfaction with the system.
You might be able to “mandate” that more people have insurance, but you can’t decree there be more doctors. It takes an average of 10 years to train a primary care physician, and seven to train a nurse practitioner and physician assistant.
How exactly can adding 35-40 million more patients to an already overloaded system work?
This article was posted: Saturday, December 14, 2013 at 5:58 am