The Affordable Care Act, aka Obamacare, became law in 2010 and provisions from the legislation began in 2014. The overall goal of the law was to provide health insurance to an increased number of Americans. To accomplish this, Obamacare created an expansion of Medicaid to include able-bodied 18 to 64 year olds and also established a health insurance exchange with premiums subsidized by taxpayers.
Obamacare has many provisions, many of which have been controversial. The law requires every adult to own health insurance, forces every health insurance company to include costly “essential benefits,” and forces these insurance companies to offer plans to anyone regardless of pre-existing conditions.
The initial insurance company participation in the Obamacare exchanges was very marginal. Many regions of the country had only one or two companies offering plans. The problem was that companies had no idea how many older, sicker patients would sign up for plans versus young, healthy patients.
It was estimated that at least 40% of enrollees needed to be young and healthy to offset the costs of the sicker patients. Over the past 10 years, the government has increased the taxpayer subsidies in the exchanges to encourage more insurance companies to participate.
Competition among insurance companies for patients in the exchanges has now increased. No surprise, companies are looking for ways to hold costs down, especially when the number of young and healthy patients has never reached the required 40%. One proven way for companies to keep their costs low is to pay doctors less than private insurance and less than their competitors. Of course, fewer physicians want to participate with these companies, which creates a limited network of doctors for patients.
A recent study by KFF, formally known as The Kaiser Family Foundation, found that on average, patients in Obamacare exchanges had access to only 40% of doctors in any one given area. A quarter of patients had access to only 25% or less of physicians in their communities. Interestingly enough, the narrowest networks were in larger metro areas where patients had access to only 34% or less of doctors.
Physician participation in Medicaid, the other health insurance expansion in Obamacare, is a bit better. On a national basis, roughly 70% of all doctors accept Medicaid patients, even with the poor reimbursements of 35% to 40% of what private insurance pays.
When President Obama signed the ACA into law, one of his famous lines was “if you like your doctor, you can keep that doctor.” It turns out that many Americans can’t keep their doctor or at least have a limited choice of who they can see. This is yet another example of “buyer beware” when government officials make promises.
