Obamacare: With 7 million enrolled, physicians consider the future

While the White House has announced that more than 7 million people signed up for the Affordable Care Act, some doctors wonder if some of the ACA provisions will have them working harder for less money.

For physicians, questions remain about the implications of some terms of the law. Provisions in the ACA allow insurers to withhold payments to healthcare providers for up to 90 days, or deny claims when subsidized patients fail to pay their insurance premiums.

“Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers,” American Medical Association president Ardis Dee Hoven, MD, said in a press release.

The provisions prompted the AMA to issue new resources for physicians.

“The grace period rule imposes a risk for uncompensated care on physicians so the AMA has created resources to help medical practices navigate the key aspects of the rule to minimize its potential negative impact,” Hoven said.

Cardiology Today Editorial Board member and cardiologist at Columbia-St. Mary’s Healthcare in Milwaukee, L. Samuel Wann, MD, MACC, FESC, said the issues related to the new law will take time to fix.

L. Samuel Wann

“I think it’s a continuing adjustment to the fact that this is a very complex and difficult program to put into place,” he said. “When Medicare was introduced, there were a lot of doubts and a lot of problems, and it still has some problems, but it works. As we go along, the ACA can be fixed. It’s not perfect, but I think we should be glad to have 7 million more people insured.”

While Wann believes problems will be addressed, he shared concerns about reimbursements to physicians.

“I wonder how much they are going to pay us to deliver this care. For physicians, the question is: At the end of the day, are we going to work harder for less?”

Wann said the cost structure also needs to be fair.

“The insurance companies potentially stand to make a lot of money, but we deliver services and they decide. If the government is going to let the insurance companies in on the profit, then they should have to be in on the risk,” Wann said. He added that the enrollment numbers may not translate into high enrollment over time. “I think the political twist is that the number of people who have signed up isn’t equal to the number of people who are going to pay premiums.”

Richard O. Dolinar, MD, clinical endocrinologist, and a senior fellow with the Heartland Institute, also said the number of people with subsidized insurance will be very small compared with the rest of the population, making the risk of non-payment low.

Richard O. Dolinar

“I’m guessing the impact is going to be pretty minimal unless you have the kind of practice where a lot of [subsidized] patients are coming in. If you’re seeing patients and not generating enough income, then your practice is going to end,” Dolinar said. “All things unsustainable eventually end.”

Others praise the addition of more insured patients, which includes 3 million Americans under the age of 26 who are also insured under parents’ insurance policies, and, in some states, those without insurance covered through Medicaid expansions.

Elliott Antman

President-elect of the American Heart Association, Elliott Antman, MD, said, “I’m delighted to see the enrollment that has been reported for the Affordable Care Act. There are probably 122 million Americans with preexisting conditions, and from the perspective of the American Heart Association, we know that 84 million, or about 70% of them, are living with heart disease, stroke or other cardiovascular-related conditions. Before the ACA took effect, many of them were at risk of being uninsured through their job. … This is a serious problem because cardiovascular disease is prominent in this country and contributes to the morbidity, mortality and cost to our healthcare system.” – by Shirley Pulawski

Disclosures: Wann and Dolinar report no relevant financial disclosures.