WaPo: No, you can’t keep your doctor or your hospital in ObamaCare

posted at 8:41 am on November 21, 2013 by Ed Morrissey

The collapse of the “if you like your plan, you can keep your plan” pledge has outraged millions of Americans who got cancellation notices from insurer over the last few weeks.  The second part of that pledge, in which Barack Obama promised that those who liked their providers would not be forced to switch, is just as false, reports the Washington Post today.  In the latest belated media discovery about the cost-containment mechanisms of ObamaCare, the Post notes that a gap has now opened on provider access between individual and group plans that didn’t exist before:

As Americans have begun shopping for health plans on the insurance exchanges, they are discovering that insurers are restricting their choice of doctors and hospitals in order to keep costs low, and that many of the plans exclude top-rated hospitals.

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The decisions have provoked a backlash. In one closely watched case, Seattle Children’s Hospital has filed suit against Washington’s insurance commissioner after a number of insurers kept it out of their provider networks. “It is unprecedented in our market to have major insurance plans exclude Seattle Children’s,” said Sandy Melzer, senior vice president.

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

Welcome to Government Insurance! Hey, you didn’t really need a top-flight surgeon for your condition anyway.  Maybe you should just take a pill.

That’s not really an option for Jeffrey Blank, whose daughter has a rare bone disorder.  Childrens Hospital of Seattle had been managing her case for a while, but now his new (and improved!) ObamaCare-driven plan won’t pay for the visits.  The need to hold costs down as higher-risk members flood into the risk pools forced insurers to concentrate on community hospitals rather than specialty hospitals and providers, and that means that millions of people who have had an ongoing and successful relationship with their providers will have to start all over — and hope that it doesn’t make their situation worse.

It’s not just the hospitals, either.  McClatchy and Kaiser Health News report that doctors are balking at the new reimbursement schedules, too, and may opt out of exchange-based plans:

Many doctors are disturbed that they’ll be paid less – often a lot less – to care for the millions of patients who are projected to buy coverage through the health law’s new insurance marketplaces.

Some have complained to medical associations – including those in Texas, California, Georgia, Connecticut and New York – saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, perhaps making it harder for consumers to get the care they need.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington.

If providers are paid less, he said, “Are (enrollees) going to have difficulty getting physicians to accept them as patients?”

Before ObamaCare, of course, insurers, doctors, and patients could make that decision on their own.  Silly patients! Thanks to Barack Obama, now we can all be free to not get service from the people who really know us and our conditions, and get forced into community care instead.

None of this is news, actually.  Republicans have warned about this for years, and even the New York Times  figured it out by September. CNN reported on the White House anxiety over this more than two weeks ago.  Perhaps it would have helped if these media outlets had been more curious about the cost-saving claims of ObamaCare in, oh, 2009.


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Didn’t we know this three years ago when we ended all our correspondence with “But…But…But…I can keep my doctor, right?”

dirtseller on November 21, 2013 at 8:43 AM

This is why I think a government run system will start occurring and they will force doctors to accept it. The quickest way to anger someone is to say their world-renowned doctor costs too much and they should go to a guy who just got out of med school.

txaggie on November 21, 2013 at 8:45 AM

Why are the democrats effing around with my health care?

Lonetown on November 21, 2013 at 8:47 AM

It’s horrible. I love our family doctor and he has been a source of comfort and stability, lo these many years. I really believed it when we were told that we could keep our doctors under ACA. I am sorely disappointed and I don’t know where we’ll turn. My premiums are also up.

BUT I STILL LOVE OBAMA AND I SUPPORT OBAMACARE! ALL HAIL THE DEMOCRATS FOR CARING ABOUT THE LITTLE GUY AND FOR PROTECTING US FROM TED CRUZ!

/you know it’s coming

mankai on November 21, 2013 at 8:48 AM

But upper-middle-class Sandra Fluke had to have other Americans pay for her contraception, doncha know.

BuckeyeSam on November 21, 2013 at 8:49 AM

Why are the democrats effing around with my health care?

Lonetown on November 21, 2013 at 8:47 AM

Because you might think you’re happy, but you’re not.

mankai on November 21, 2013 at 8:49 AM

That’s not really an option for Jeffrey Blank, whose daughter has a rare bone disorder. Childrens Hospital of Seattle had been managing her case for a while, but now his new (and improved!) ObamaCare-driven plan won’t pay for the visits.

It’s clear that Barry Hussein Obama hates children (“punished with a baby.”)

rbj on November 21, 2013 at 8:51 AM

I remember downloading a long document from the Heritage Foundation or some other conservative think tank in 2009 or 2010. Anyway – it detailed the law in language laymen could read and all of this was in there. None of this was a surprise to me, at all, or to anyone who reads this blog or ACE or Instapundit or….

djl130 on November 21, 2013 at 8:51 AM

That’s not really an option for Jeffrey Blank, whose daughter has a rare bone disorder. Childrens Hospital of Seattle had been managing her case for a while, but now his new (and improved!) ObamaCare-driven plan won’t pay for the visits.

But I thought that Jeff’s previous plan was substandard and crappy…..What say you Jay Carney???

ted c on November 21, 2013 at 8:52 AM

Ok. I’m now convinced: GOP – don’t do anything except watch it burn.

Tsar of Earth on November 21, 2013 at 8:52 AM

and I thought that Jeff’s daughter wouldn’t be thrown off her plan because of a preexisting condition? Let me guess, her contraceptives are covered but her bone marrow disorder isn’t..…. nice work, Dr. Obama…./

ted c on November 21, 2013 at 8:53 AM

Perhaps it would have helped if these media outlets had been more curious about the cost-saving claims of ObamaCare in, oh, 2009.

CNN and the NYT are reporting that Hitler might not be serious about those Munich Accords… they’re also warning the people of Troy to be wary of any large wooden gifts.

mankai on November 21, 2013 at 8:53 AM

Big deal about the Mayo, it’s not as if the place is a world-class institution with some of the most skilled doctors who ever existed.

Just head on down to the People’s Free Community Co-oP Clinic in the warehouse district, there’s a Bangladeshi “doctor” there who would love to use you as practice to improve his subpar surgical skills.

Bishop on November 21, 2013 at 8:53 AM

These are bellicose moves, I am increasingly convinced.

ted c on November 21, 2013 at 8:54 AM

The Clinton’s are starting to claim some distance from this train wreck policy. Last night Hillary consigliere Lanny Davis called for a “reset” on ZeroCare, which in my too hopeful way I interpreted as “repeal” until a helpful acquaintance pointed out we are talking in Clinton-speak now and “reset” can mean almost anything.

Maybe Sergei Lavarov can help me.

MTF on November 21, 2013 at 8:54 AM

This is the type of thing that will drive the traitor’s approval numbers into the 20′s. He shouldn’t be allowed to walk away from this. His fraud should be prosecuted and obozo and his cronies should rot in prison.

Flange on November 21, 2013 at 8:55 AM

“But since they have expanded health insurance in Massachusetts, the demand for care has grown, even as the supply has remained unchanged. As a result, the time price of care has increased. The wait to see a new doctor in Boston is two months ― the longest waiting time in the entire country. People are getting the same care they got before, but they are paying a higher “price” for it.

I expect to see the Massachusetts results replicated nationwide.

In the developed world, the health policy community is excessively focused on health insurance, even to the point of ignoring health care. In fact, studies of waiting times and inability to get care are often derided as right wing attempts to undermine the concept of social insurance. The less developed world has the opposite vision. Almost all the countries south of our border generally offer free care to the general population. But they don’t go around handing everyone an insurance card.

I believe this difference in vision is partly explained by the difference in income and wealth. Middle- and upper-middle income families need insurance to protect their assets. Poor families don’t have assets. They don’t need insurance. They may need health care, however.

ObamaCare was designed by middle- and upper-middle income people. They chose for poor people the same thing they would want for themselves. They didn’t think about access to care because they have never had a personal problem with it….”

http://healthblog.ncpa.org/devastating-news-for-obamacare-backers/

workingclass artist on November 21, 2013 at 8:57 AM

This really is a bridge too far. I can’t see Americans accepting this kind and level of healthcare dislocation.

People who are dislocated in this manner should become known as Obamacare refugees.

BuckeyeSam on November 21, 2013 at 8:58 AM

No sympathy

You wanted this….live with it

cmsinaz on November 21, 2013 at 8:58 AM

Doctors are racist, just like insurance companies, oil pipe lines, mortgage companies and Wal-Mart.

We need the Democrats to protect us from them all. What could go wrong?

mankai on November 21, 2013 at 8:58 AM

I have had the privilege to work closely with some of the best surgeons in the world. This law is going to prove deadly. Because of Barack Obama – literally – people are going to die next year. When that happens, this is going to morph into something we haven’t seen in this country. It won’t be pretty.

HomeoftheBrave on November 21, 2013 at 8:59 AM

I just hope John Roberts sleeps well at night.

Cleombrotus on November 21, 2013 at 9:01 AM

Lol ted c…lsm keeps with that substandard care meme for dear leader

Idiots

cmsinaz on November 21, 2013 at 9:02 AM

So what you are left with is a Haitian Voodoo witch doctor…

“Just swing that dead chicken over your head three times and take this pill, everything be gooood man”….

Hope you enjoy your new healthcare all you morons that voted for this idiot…

PatriotRider on November 21, 2013 at 9:02 AM

OT…..Reid is going for the nuclear option

cmsinaz on November 21, 2013 at 9:02 AM

I have had the privilege to work closely with some of the best surgeons in the world. This law is going to prove deadly. Because of Barack Obama – literally – people are going to die next year. When that happens, this is going to morph into something we haven’t seen in this country. It won’t be pretty.

HomeoftheBrave on November 21, 2013 at 8:59 AM

When somebody’s kid dies because of this…there is going to be hell to pay…

PatriotRider on November 21, 2013 at 9:04 AM

Perhaps it would have helped if these media outlets had been more curious about the cost-saving claims of ObamaCare in, oh, 2009.

As I recall, Ed, we had a few words about these false claims back then right here on HotAir…. The media was busy breaking in their knee pads back then.

ted c on November 21, 2013 at 9:05 AM

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

Of course this has to happen. You see, when the “average American” gets sick, they will go to clinics. When the “Above Average Americans” get sick, they will be able to go to these fine hospitals and they won’t have to deal with the riff raff.

Wouldn’t really be able to tell who the “Above Average Americans” are if they are going to the same hospitals as the common folk.

dirtseller on November 21, 2013 at 9:06 AM

But look: Even the clown show at HHS will, given enough time, pull its act together and get the federal website running.

and then hotair will run out of material to bash the President on…that’s what you’re really afraid of, right?

nonpartisan, Juris Doctor on November 19, 2013 at 4:47 PM

NotCoach on November 21, 2013 at 9:08 AM

How much longer are the citizens of this country going to let themselves be horse whipped by the government? You’ve been lied to, cheated and are seeing your freedoms taken away . . . wake up people before it’s too late.

rplat on November 21, 2013 at 9:08 AM

OT…..Reid is going for the nuclear option.

THe Democrats only hope is to Rahm this through, once again, only this time use the courts. I hope the Republicans call their bluff on this one because it will be the final nail in the coffin of the Democrats. In fact, if they change the filibuster rules to pack the D.C. court, which would be unheard of, then I think, when the Republicans get both Houses, they should impeach those judges because of how they were installed.

For those people who allowed this to happen, last election, I hope you’re enjoying what you’ve done to the country. As for John Roberts, first I can’t imagine he’s happy, but I doubt even he thought Obama and company would screw this up this badly.

bflat879 on November 21, 2013 at 9:09 AM

When somebody’s kid dies because of this…there is going to be hell to pay…

PatriotRider on November 21, 2013 at 9:04 AM

If the press bothers to cover it.

mankai on November 21, 2013 at 9:09 AM

OT…..Reid is going for the nuclear option

cmsinaz on November 21, 2013 at 9:02 AM

He’s got nothing to lose. Pack the courts before the 2014 elections when all hell breaks loose.

NotCoach on November 21, 2013 at 9:09 AM

In St. Louis, prestegeous, Barnes Hospital, staffed by doctors from top five ranked Washington University physicians are EXCLUDED from either of the plans. That includes Children’s Hospital, Siteman Cancer Center and the Kling Proton Center. You cannot even offer to pay more for this access. It isn’t available. Not a death panel. A death sentence if you have a complex cancer.

flyoverland on November 21, 2013 at 9:12 AM

Big deal about the Mayo, it’s not as if the place is a world-class institution with some of the most skilled doctors who ever existed.

Just head on down to the People’s Free Community Co-oP Clinic in the warehouse district, there’s a Bangladeshi “doctor” there who would love to use you as practice to improve his subpar surgical skills.

Bishop on November 21, 2013 at 8:53 AM

Yep.

gophergirl on November 21, 2013 at 9:12 AM

and then hotair will run out of material to bash the President on…that’s what you’re really afraid of, right?

nonpartisan, Juris Doctor on November 19, 2013 at 4:47 PM

Hogwash, he’s not being bashed . . . he’s being called out for this blatant incompetence, lack of character and incessant lying. Only a mindless, dependent fool would continue to defend this behavior.

rplat on November 21, 2013 at 9:12 AM

and I thought that Jeff’s daughter wouldn’t be thrown off her plan because of a preexisting condition? Let me guess, her contraceptives are covered but her bone marrow disorder isn’t..…. nice work, Dr. Obama…./

ted c on November 21, 2013 at 8:53 AM

She’ll also get annual prostate exams. Problem solved.

RandallinHerndon on November 21, 2013 at 9:15 AM

Only a mindless, dependent fool would continue to defend this behavior.

rplat on November 21, 2013 at 9:12 AM

Nonpartisan, Juris Doctor, thanks you for the compliment.

NotCoach on November 21, 2013 at 9:16 AM

Ah. All these Doctors are substandard anyway. The new Obamacare Doctors will be better.

oldroy on November 21, 2013 at 9:17 AM

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

The goal of socialism is to create two tiers system… One tier for 99% of the population where everyone is equally poor and miserable… Another tier is for the 1% of the socialist rulers and socialists elite who have everything… And the 1% will force the 99% to worships them as gods… Unfortunately for the socialists it is not going to happen in America because we have GUNS…

mnjg on November 21, 2013 at 9:17 AM

AND THE REALLY FUNNY PART OF THIS WHOLE MESS IS THAT IT WAS PREDICTED 3 1/2 YEARS AGO WHEN THOSE STUPID ASSES PASSED THIS POS LEGISLATION!

GarandFan on November 21, 2013 at 9:18 AM

Do you know where your personal data is going?

After meeting with several Obamacare Navigators who openly encouraged our undercover reporters to lie about income status, health history and more, it became clear that personal data was also being “cross-pollinated.”

Enter Enroll America, a Sebelius-linked group dedicated to signing people up for Obamacare and Chris Tarango, Texas Enroll America Communications Director who Project Veritas caught on tape agreeing to help obtain a private list of potential Obamacare enrollee data for election/political purposes. Tarango goes so far to say he’ll “Do whatever it f****** takes.”

Project Veritas

Akzed on November 21, 2013 at 9:19 AM

Just head on down to the People’s Free Community Co-oP Clinic in the warehouse district, there’s a Bangladeshi “doctor” there who would love to use you as practice to improve his subpar surgical skills.

Bishop on November 21, 2013 at 8:53 AM

Bangladeshi hater.

oldroy on November 21, 2013 at 9:20 AM

But, Obama told me my health care would be better and cheaper. WTH? Damn George W. Bush!!

RandallinHerndon on November 21, 2013 at 9:21 AM

So every ones “crappy plans” just got crappier.

docflash on November 21, 2013 at 9:21 AM

Ah. All these Doctors are substandard anyway. The new Obamacare Doctors will be better.

oldroy on November 21, 2013 at 9:17 AM

Obamacare doctors with fresh diplomas from the Josef Mengele School of medicine. I’m reassured, now.

RandallinHerndon on November 21, 2013 at 9:23 AM

I mentioned in another thread over a month ago, that this is almost exactly what’s happened to me.

Here’s the remedy.

It’s called self-pay.

If you already have a family physician, they’ll keep you as long as you go cash.

The cash rate is less than the insured, but better than the medicaid/0Care pay out.

Then use your insurance for the larger stuff – hospitals, bloodwork, x-rays, ER…

budfox on November 21, 2013 at 9:24 AM

Hopeys HealthCare Legacy is,

…….********** SCROTCHED *****************~~

1. scrotched

Totally f**ked up beyond all repair
Dude, that sh*t is scrotched

canopfor on November 21, 2013 at 9:24 AM

+1 bflat

Notcoach…. hell will definitely break loose

cmsinaz on November 21, 2013 at 9:26 AM

Obama’s going down and he’s taking the MSM with him. Make no mistake – they KNEW all the pitfalls of this disaster called ObamaCare but chose not to report on it.

/Malfeasance & Malpractice from the Oministration and its Merry Minstrels in the MSM.

Key West Reader on November 21, 2013 at 9:26 AM

Why do the democrats hate children? Even that elderly buffoon harry reid, when asked if they could agree on funding cancer research for children replied, “why would I want to do that?”

Seems the democrats want children and the elderly to suffer because universal health care.

These people should be publicly shamed and scorned, turned into pariahs.

rightside on November 21, 2013 at 9:28 AM

Hmmmmmmmmmmmmmmmmmmmmmmmmmmm,………………..

health care
44m
====

US spends significantly more per person on health care than other countries, but has lower life expectancy rates than its peers, new report from the Organization for Economic Co-operation and Development says – @OECD_Pubs
=================

Health at a Glance

Health at a Glance 2013
OECD Indicators
***************

OECD

Publication Date :
21 Nov 2013
****************
ISBN :
9789264204225 (HTML) ; 9789264205024 (PDF) ; 9789264200715 (print)
DOI :
10.1787/health_glance-2013-en

This seventh edition of Health at a Glance provides the latest comparable data on different aspects of the performance of health systems in OECD countries. It provides striking evidence of large variations across countries in the costs, activities and results of health systems. Key indicators provide information on health status, the determinants of health, health care activities and health expenditure and financing in OECD countries. Each indicator in the book is presented in a user-friendly format, consisting of charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings conveyed by the data, and a methodological box on the definition of the indicator and any limitations in data comparability.
===============

http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2013_health_glance-2013-en

canopfor on November 21, 2013 at 9:28 AM

We just received a letter from my husband’s cardiac care group saying they may no longer accept our Blue Cross Blue Shield and that they are in negotiations with BCBSTX. If it comes to pass that they stop accepting our insurance, the alternatives are questionable.

That’s a big effin deal.

tru2tx on November 21, 2013 at 9:30 AM

I just hope John Roberts sleeps well at night.

Cleombrotus on November 21, 2013 at 9:01 AM

Why shouldn’t he sleep well…He doesn’t have to live under the same laws we do.

He’s part of the Aristocracy.

workingclass artist on November 21, 2013 at 9:36 AM

In keeping with our grammatical evolution (see Headlines) may I suggest that the media was either not curious or chose to deceive their readership about the cost- saving claims of ObamaCare … because Democrats.

Blaise on November 21, 2013 at 9:36 AM

We just received a letter from my husband’s cardiac care group saying they may no longer accept our Blue Cross Blue Shield and that they are in negotiations with BCBSTX. If it comes to pass that they stop accepting our insurance, the alternatives are questionable.

That’s a big effin deal.

tru2tx on November 21, 2013 at 9:30 AM

Yeah.

Obamacare hits Cardiologists & Oncologists and other specialists hard and patients will suffer.

“First, Obamacare is going to block the ability of patients to seek out the specialist doctors who are most likely to prescribe these cutting edge treatments.

Obamacare coaxes health plans to reduce spending and healthcare utilization by limiting the choices patients will have of doctors. This is the primary way that health plans are being cheapened enough to meet Obamacare’s strict guidelines on the low value of the coverage that the plans can offer.

Insurers are barred from using the other tools that they’ve traditionally employed to keep the costs of policies in check: cost sharing, underwriting risk, adjusting premiums and benefits. The only thing that health plans are permitted to do under Obamacare is narrow the networks of providers that they contract with. So that’s precisely what they’re doing. By contracting with fewer providers, insurers can cheapen their coverage by clamping down on what doctors prescribe…”

http://www.forbes.com/sites/scottgottlieb/2013/08/21/how-obamacare-will-harm-cancer-patients/

workingclass artist on November 21, 2013 at 9:42 AM

“The Affordable Care Act, or Obamacare, cuts $734 billion dollars from Medicare funding over 10 years, starting in 2014. The bulk of these funding cuts will result in defunding Medicare Advantage plans. Remember: You can keep your plan if you like it. Period.

Insurers who offer Advantage plans are killing their plans in a very clever way. They are dropping doctors from their Advantage panels.

United Health Care just announced that it will cut 2,000 doctors from their Advantage plans and another major health insurer, Aetna, is considering actions to address this drastic defunding by the government.

Doctors are being dropped from Advantage panels in Ohio, Connecticut, New Jersey and Florida and this is just the beginning. Remember: “You can keep your doctor if you like him/her.”

When any of the 14.4 million persons with Medicare Advantage coverage lose their doctor or specialists, they either have to find new, participating doctors and specialists that are accessible or drop their Advantage coverage and revert to Medicare and a Supplement Plan that is accepted by their previous doctors.

Many doctors who are witnessing their fellow physicians being used as pawns in the deadly game of Obamacare, are no longer accepting Medicare patients. If a patient with a chronic health condition is forced to change doctors, continuity of care will be impacted as could patient longevity.

And If seniors die sooner under Obamacare due to restrictions on receiving specific medical procedures based on their age and overall health, as is the practice in countries with socialized medicine, the government saves money in other ways.

It saves money because it pays senior’s medical bills and Social Security for fewer years. And you thought Obamacare was about healthcare.

It has always been about power, control, and buying votes and seniors who have worked most of their lives and find themselves in the twilight of their years will be forced to bear the brunt of this disgraceful scheme….”

http://www.pennlive.com/opinion/index.ssf/2013/11/heres_how_obamacare_targets_seniors_pennlive_letters.html

workingclass artist on November 21, 2013 at 9:46 AM

Because Utopia.

mankai on November 21, 2013 at 9:48 AM

Why would you want to keep your doctor? He just wants to cut off your feet and remove your tonsils to make a quick buck.

/Obama

gwelf on November 21, 2013 at 9:50 AM

Why do the democrats hate children? Even that elderly buffoon harry reid, when asked if they could agree on funding cancer research for children replied, “why would I want to do that?”

Seems the democrats want children and the elderly to suffer because universal health care.

These people should be publicly shamed and scorned, turned into pariahs.

rightside on November 21, 2013 at 9:28 AM

Culture of Death.

workingclass artist on November 21, 2013 at 9:54 AM

Any recent polls on what Americans think of the SCOTUS..?

d1carter on November 21, 2013 at 9:55 AM

Doctors are not going to participate in this fiasco and those that do will have long wait lists to get in to see. Congrats you have insurance, the doctor will see you in 8 weeks.

Ellis on November 21, 2013 at 9:56 AM

I’m sure the doctors will be demonized…because Greed

“Many doctors are disturbed that they’ll be paid less – often a lot less – to care for the millions of patients who are projected to buy coverage through the health law’s new insurance marketplaces.

Some have complained to medical associations – including those in Texas, California, Georgia, Connecticut and New York – saying the discounted rates could lead to a two-tiered system in which fewer doctors participate, perhaps making it harder for consumers to get the care they need.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington.

If providers are paid less, he said, “Are (enrollees) going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge that they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

But many primary care doctors say they barely have time to take care of the patients they have now.

The conflict sheds light on the often murky world of insurance contracts, in which physicians don’t always know which plans they’re listed in or how much they’re being paid to treat patients in a particular plan. As a result, some doctors are just learning about the lower pay rates in some plans sold in the online markets, or exchanges

“If you’re a physician and you’ve negotiated a rate from insurance, shouldn’t it be the same on or off the exchange?” said Matthew Katz, the executive vice president of the Connecticut State Medical Society. “You’re providing the same service.”

A senior executive at Blue Cross Blue Shield Association said some of its 37 member organizations – each of which operates independently and offers a variety of plans – were offering lower rates to physicians in smaller exchange plan networks.

But, she said, plans know that a good network of providers is essential or customers will go elsewhere, so they are enlisting sufficient numbers of doctors.

“We’re not motivated to gouge the doctor,” said Kim Holland, the Blue Cross Blue Shield Association executive director for state affairs. “We depend on good relationships with quality physicians. . . . I can’t imagine any product we offer is going to have a physician rate that would discourage them from seeing a patient.”

But some physicians see things differently. Contracts between insurers and doctors vary, and some allow insurers to adjust rates unilaterally or to assign doctors to multiple plans.

“I’ve participated with Oxford since 1985,” Dr. Paul Orloff, a physician who’s the president of the New York County Medical Society, said of Oxford Health Plans. “They don’t send me a contract every year to sign. They don’t send me the rates. You don’t know the rates. It’s the only game in town, so you sign. They have a right to unilaterally change the rates at any time during the contract.”

The benchmark for physician fees is the rate the federal government sets for services provided to older Americans through Medicare. In many markets, commercial plans may pay slightly above the Medicare rates, while doctors say that many of the new exchange plans are offering rates below that.

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.

Some experts minimized the impact of lower pay rates on enrollees.

People “may experience wait times to get in, but that is not unique to people in exchange plans,” said Sara Rosenbaum, a professor of health law and policy at George Washington University,

Rosenbaum said she was not overly concerned about physicians’ compensation. “I don’t mean to suggest that physicians don’t deserve to do well,” she said. “But physicians are very well-compensated people, no matter what.”

Many doctors say they have not decided if they will participate in the new plans; in some cases, even when insurers are including them in their provider lists.

A survey by the Medical Society of the State of New York found that 40 percent of more than 400 physicians who had responded so far said they’d chosen not to participate in a health insurer’s exchange plan, and one-third said they did not know whether they were participating or not.

Patricia McLaughlin, an ophthalmologist in New York City, said patients had called her office, saying, ‘Oh good, I see you’re in the network.’ I’m not sure I am or am not at this point.”

Some insurers have contractual arrangements with physicians that allow them to include doctors in new plans automatically, unless the physicians request to opt out in writing, according to Mike Scribner, the CEO of Strategic Healthcare Partners, a health care consulting firm based in Savannah, Ga., that represents about 700 physicians and 30 managed care hospitals in the state.

Dr. Richard E. Thorp, an internist who’s the president of the California Medical Association and heads a physician-owned multi-specialty primary care group in Paradise, Calif., said that one plan sold on his state’s exchange “was going to pay us significantly less for doing that business. And we are already very busy.”

His practice delayed signing a contract, he said. But about three weeks ago, the group was informed that the insurer was short on physicians and was therefore including doctors from other plans at their old rates. So his practice was included at the higher rate.

Advocates say consumers should be wary of information in plan directories and confirm participation with their doctors….”

Read more here: http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html##storylink=cpy

workingclass artist on November 21, 2013 at 9:59 AM

Just got back from one of my doctors offices.. I have 4. I asked him directly about ACA, and he was hesitant to answer for obvious reasons, but I told him I opposed single payer, where this is being driven…

I pointedly said, what doctor wants to train for 12 years, to be a minor level government salaried employee?…

His eyes said everything.. The medical community is going to pushback, hard.. You don’t sacrifice all those years, the time, the debts.. all to be “Joe” at the local chop shop..

I’m fully disabled, on Medicare, payouts shot up 300%.. Workers Comp largely unaffected, except they only cover half my condition.. and they re-enforce why you never want government anywhere near your health insurance, let alone making medical decisions for you…

and when the employer mandate kicks in, my wife will loose her insurance.. The kids are on Medicaid, because of me being on Medicare..

None of these choices were mine..

I’d go with privatizing the whole thing tomorrow.. because never, ever has private insurance screwed me and my family like government care has.

I have kids to feed and raise.. and they think we should pay higher costs to cover people who for the most part, make more than we do..

Obama can rot in Hell, and take liar Reid and that dunce Pelosi with him.

mark81150 on November 21, 2013 at 9:59 AM

Doctors are not going to participate in this fiasco and those that do will have long wait lists to get in to see. Congrats you have insurance, the doctor will see you in 8 weeks.

Ellis on November 21, 2013 at 9:56 AM

Well I suppose the next step is to deny license to practice…eh?

workingclass artist on November 21, 2013 at 10:00 AM

Deny license to practice? Good luck ever getting that law passed. Repeal stands a better chance.

Ellis on November 21, 2013 at 10:03 AM

From the comment thread at the McClatchy article…(Works at Mayo Clinic)

“Our office overhead and malpractice insurance costs are numbing and continue to climb. The regulatory & compliance demands spiral upwards. Reimbursement continues to decline. It “costs” us a cup of coffee when we see a Medicare patient and a small lunch when we see a Medicaid patient….the reimbursement does NOT cover the cost. You cannot make up for a loss by increasing volume! You can make up for a loss by not seeing the patients that cost one’s practice. It is not rocket science. It isn’t even Economics 101! I was planning on working until 70, because I so thoroughly enjoy my profession. I am now planning on retiring as early as I can.

One other thing the number-crunchers fail to realize is that the number of new doctors is not the number of new doctors is not the number of new doctors. In “my generation” of doctors, 90% were male and a 60-70 hour work week is a “light” week. The “new” doctors are 50% female and after maternity leaves and babies, often return to part-time practice. The rest are concerned more with “life-style” and rarely work 40 hours/week. Numbers are numbers, but reality is different. It will take a LOT more doctor numbers to replace the soon-to-be retiring docs!

One last comment: I have NEVER been able to “negociate” with insurance companies for reimbursement rates. They are dictated to you. You take it or leave it. I recently told two carriers to forget it. Made my day!…”

****

Another comment…

“Next step: when the doctors start to reject low-paying insurance carriers, Mother Government will step in to force them to, by law. Before you know it, all medical services providers will be government employees and there will be one single “insurance” company: the US Government. Still happy you invested all that money in med school, docs?”

response comment:

“as a retired MD–that is EXACTLY what will happen or they will not renew your medical license….”

http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html#

workingclass artist on November 21, 2013 at 10:09 AM

They think it’s bad now?

Half the doctors in this country are at or near retirement age.. They get shafted, they retire.. and the doctor pool shrinks to the point of desperation.. What’s ol feckless Obama going to do?

Draft them into the Army at gunpoint?

These idiots took a system which worked well for 85%, and and are destroying it to force under 30′s into the system.. when a cheap catastrophic plan was all they wanted or needed..

The poor already had Medicaid, bankrupt as it is..

So what happens when the new “system” starts letting people die to cut costs? Think Julia will still love Obamacare when it murders her 68 year old mother with a heart condition?.. or her kid who has Leukemia?

This train wreck is headed for a democrat base revolt, as they discover that it’s not just screwing the republicans they hate so much.

mark81150 on November 21, 2013 at 10:10 AM

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

I accept this statement. Another question: if a person buys Plan X with health insurance company B through the government exchange with a subsidy, will they end up in a different network than the person that buys Plan X with health insurance company B directly, without subsidy?

Anyone?

slickwillie2001 on November 21, 2013 at 10:15 AM

Deny license to practice? Good luck ever getting that law passed. Repeal stands a better chance.

Ellis on November 21, 2013 at 10:03 AM

Who says there needs to be a law passed?

Obama governs by executive fiat.

workingclass artist on November 21, 2013 at 10:16 AM

From the comment thread at the McClatchey article…

“This article suggest we have the beginnings of a CASTE SYSTEM in American medical care. At the top is Concierge care where a patient subscribes to a doctor or clinic for a monthly fee. Everybody else is on a sliding downward scale with access to quality care diminished by the level of the subsidy all the way down to the lowest caste – Medicaid. If a doctor has two patients in need of a knee replacement and one is affluent enough to pay cash and the other is a heavily subsidized patient, who will the doctor choose to treat first? The Caste System begins.”

reply:

“I worked at a health system a few years back and we owned two hospitals. We had a consultant group come in whose specialty was the future of healthcare in America. Their suggestion was to begin the process of taking our two facilities and making them tiered. One facility would be for those with higher end coverage or would be willing to pay out of pocket for higher end concierge type services. The other hospital would be for everyone else. It was an eye opening presentation that made me very uncomfortable, but I really wonder now just how right they could end up being in the end.” – (Director Medical Payment Strategy and Policy at UPMC Health Plan)

http://www.mcclatchydc.com/2013/11/20/209165/doctors-are-concerned-about-pay.html#

workingclass artist on November 21, 2013 at 10:23 AM

mark81150 on November 21, 2013 at 10:10 AM

Occupy Hospitals or something…

It’s gonna get ugly real quick.

workingclass artist on November 21, 2013 at 10:29 AM

It’s horrible. I love our family doctor and he has been a source of comfort and stability, lo these many years. I really believed it when we were told that we could keep our doctors under ACA. I am sorely disappointed and I don’t know where we’ll turn. My premiums are also up.

BUT I STILL LOVE OBAMA AND I SUPPORT OBAMACARE! ALL HAIL THE DEMOCRATS FOR CARING ABOUT THE LITTLE GUY AND FOR PROTECTING US FROM TED CRUZ!

/you know it’s coming

mankai on November 21, 2013 at 8:48 AM

I think you need a head doctor!

lhuffman34 on November 21, 2013 at 10:36 AM

the Post notes that a gap has now opened on provider access between individual and group plans that didn’t exist before:

Don’t be so sure about that gap, Obamacare limits how much of the added insurance costs businesses can pass on as employee contributions. Do they really believe businesses are just going to eat the added costs?

agmartin on November 21, 2013 at 10:42 AM

It’s gonna get ugly real quick.

workingclass artist on November 21, 2013 at 10:29 AM

Hopefully there is still enough Americans around (with basic math skills) that are willing to push back. If it doesn’t happen soon, it either wont happen at all or will not be effective.
Let’s face it here, this was unworkable from day one. Bambicare does NOTHING to reduce the cost of delivering health care. Nothing that promotes competition in a meaningful way, nothing that encourages (in fact just the opposite)more people getting into the medical provider (doctors, etc.) field, and nothing that reduces the massive overhead generated by fear of liability . Reduce the supply, reduce the reward, increase the demand. How ignorant would one have to be to think this had a snowballs chance in hell of working on ANY level?

JusDreamin on November 21, 2013 at 10:48 AM

“”I just don’t expect anything positive out of getting free health care,” she said. “I don’t see why other people should have to pay for my care, whether it be through taxes or otherwise.” In paying for health insurance herself—she won’t accept help from her family, either—she was safeguarding her dignity and independence and her sense of being a fully functioning member of society.

Before ObamaCare, Medicaid was one option. Not the option. Before this, she had never been, in effect, ordered to take a handout. Now she has been forced to join the government-reliant poor, though she would prefer to contribute her two mites. The authorities behind “affordable care” had erased her right to calculate what she was willing to spend to preserve her dignity—to determine what she thinks is affordable.

That little contribution can mean the difference between dignity and despair.

For the truly poor, being institutionally forced to take welfare is demoralizing. The Affordable Care Act is at risk of systematizing learned helplessness by telling individuals like my mother that they cannot afford to care for themselves in the way they could before the law was enacted. “This makes me feel poorer than ever,” she said.

My mother grew up, one of six children, in a dairy-farming family in Wisconsin. “The way I was raised, taking government handouts is shameful,” she said. Her siblings stayed in Wisconsin, but she set out on her own. Finding herself forced onto Medicaid is not a fate that she ever would have imagined. “I guarantee I’m the only person in my family in this situation.”

http://online.wsj.com/news/articles/SB10001424052702303531204579207724152219590

workingclass artist on November 21, 2013 at 10:48 AM

It’s gonna get ugly real quick.

workingclass artist on November 21, 2013 at 10:29 AM

Hopefully there is still enough Americans around (with basic math skills) that are willing to push back. If it doesn’t happen soon, it either wont happen at all or will not be effective.
Let’s face it here, this was unworkable from day one. Bambicare does NOTHING to reduce the cost of delivering health care. Nothing that promotes competition in a meaningful way, nothing that encourages (in fact just the opposite)more people getting into the medical provider (doctors, etc.) field, and nothing that reduces the massive overhead generated by fear of liability . Reduce the supply, reduce the reward, increase the demand. How ignorant would one have to be to think this had a snowballs chance in hell of working on ANY level?

JusDreamin on November 21, 2013 at 10:48 AM

Obamacare was never designed to work on a practical level…It was designed to demoralize the nation.

Obamacare is just part of a package in the Progressive really Fascist agenda to create economic chaos and inflame class conflict.

It is a mechanism to turn American against American.

Divide & Conquer

workingclass artist on November 21, 2013 at 10:52 AM

You have to wonder how these leftists feel now that their children will suffer under their precious obamacare. Just remember lefties, you did it to yourselves.

jqc1970 on November 21, 2013 at 11:05 AM

Some site security fool, from the left, just now “if you have ins. and are lucky to be in that situation, don’t go to the site; it’s not secure and it would take 3 months to review/fix, just the security part…but, if you don’t have ins. then go there and give them your private and totally exposed information”.

What a country. The leftists hate you, yes you the little people.

Schadenfreude on November 21, 2013 at 11:14 AM

Obama- spreading the wealth… of lies… around.

profitsbeard on November 21, 2013 at 11:55 AM

Deny license to practice? Good luck ever getting that law passed. Repeal stands a better chance.

Ellis on November 21, 2013 at 10:03 AM

These are leftists we are dealing with, hardcore fascists. They will pass a law requiring doctors see all patients. Being progressives it will me named the opposite of what it really is. Something along the lines of:

The Doctor Freedom and Fairness Act.

jukin3 on November 21, 2013 at 12:00 PM