Participation under the Affordable Health Care for America Act (ACA) exchange health plans is being declined by over 214,000 American physicians, according to a new survey by Medical Group Management Association, a trade group comprised of multi-physician medical practices.
Through May 2014, a significant number of 214,524 doctors, estimated by American Action Forum, have decided to not take part in any ACA exchange services, since those plans will most likely force them to take on additional burdensome costs, according to CNSNews.com.
In addition, an estimated 70 percent of California physicians were reported to have not participated in Covered California plans in January.
Specifically, the various reasons that are forcing doctors to opt out include the fact that exchange plans are more likely to offer significantly lower reimbursement rates than private market plans, confusion among consumers about the obligations associated with high deductibles, and fear that patients will stop paying premiums and providers will be unable to recover their losses, according to the 2014 report.
Crafted in 2009, "the Affordable Care Act actually refers to two separate pieces of legislation - the Patient Protection and Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152) - that, together expand Medicaid coverage to millions of low-income Americans and makes numerous improvements to both Medicaid and the Children's Health Insurance Program (CHIP)," according to Medicaid.gov.
On the issue of low reimbursement rates and narrow networks, Obamacare reimbursements are reportedly at bottom-dollar, which is even lower than Medicare reimbursements, known to also be significantly below market rates.
"It is estimated that where private plans pay $1.00 for a service, Medicare pays $0.80, and ACA exchange plans are now paying about $0.60," a study by the think-tank American Action Forum finds. "For example, Covered California plans are setting their plan fee schedules in line with that of Medi-Cal-California's Medicaid Program-which means exchange plans are cutting provider reimbursement by up to 40 percent."
In order to make up for the lost revenue from Obamacare, physicians will be expected to increase their patient lists. However, primary care doctors are apparently already dealing with more patients than they can handle, CNSNews.com
"Furthermore, physicians are worried that exchange plan patients will be sicker than the average patient because they may have been without insurance for extended periods of time, and therefore will require more of the PCPs time at lower pay," the study reported.
Then, there is also concern among health care providers-hospitals and physicians-that patients enrolled in the new exchange plans do not fully understand their benefits and obligations, which might lead for the doctors to not receive payment at all.
According to an MGMA study, "75 percent of ACA patients that had seen doctors had chosen plans with high deductibles. Given that most of the patients are low-income, doctors are concerned that the patients cannot meet the deductibles and they will get stuck with the bill."
The chief reason, however, doctors are opting out of the exchange plan is that the HHS requirement has allowed about a million people to cancel their exchange plans and shy away from paying premiums.
According to HHS regulation, a 90-day "grace period" is provided for insurers to cover customers after they have stopped paying their premiums. During this grace period, the insurer is required to continue coverage for 30 days, but after that, it is upon the doctor to recover payment for the last 60 days directly from the patient.
Though final numbers are not available yet, current estimates indicate that nearly 1 million individuals enrolled in exchange plans have failed to pay their premiums to date.
So it would be an obvious question to ask: Why would doctors choose to take on sicker patients for less money under Obamacare, when there is an additional risk of not receiving payment at all?
