- - Wednesday, August 28, 2013


With a shortage of doctors already on the horizon, implementation of Obamacare promises only to make the matter worse.

According to the American Association of Medical Colleges, in just seven years, the nation will need 91,500 additional doctors to meet medical demand. Yet Obamacare is encouraging physicians to leave the field early while discouraging others from entering medical practice.

A 2012 survey by The Doctors Co., the nation’s largest insurer of physician and surgeon medical liability, found that most doctors believe Obamacare will worsen the doctor-patient relationship and negatively affect overall patient care. The survey found that nine of 10 physicians are now unwilling to recommend health care as a profession to a family member. Worse, the survey revealed that Obamacare is motivating doctors to change their retirement timelines: 43 percent of respondents said they are considering retiring within the next five years as a result of the law.

None of this should be surprising. The law neglects physicians’ most pressing needs, such as relief from sky-high malpractice insurance premiums via tort reform, and significantly worsens the painful problems that come with third-party payment and government red tape.

Two of the biggest problems Obamacare poses for physicians: It adds millions more patients to an already broken Medicaid program, and it raises the specter of health care rationing.

Obamacare is slated to start expanding Medicaid coverage next year, in any state that agrees, to all individuals earning up to 138 percent of the federal poverty level. This is projected to dump an additional 12 million Americans, mostly childless adults, into Medicaid by 2015.

And here’s the rub for doctors: Medicaid pays physicians only about 58 percent of what private insurance pays. These lower reimbursement rates already discourage doctors from accepting Medicaid patients — making it difficult for patients to get timely treatment and contributing greatly to overcrowding of hospital emergency rooms. A 2012 study by Sandra L. Decker, an economist, found that nearly one of three primary care physicians said they would not accept new Medicaid patients in 2011.

As millions more patients enroll in this broken program, it will place even greater financial strain on physicians who treat them. Doctors will be faced with the decision to either discontinue treating Medicaid patients or accept even more patients at the lower payment rate — at which point quality of care concerns must spike.

Obamacare tries to ameliorate the problem with a temporary increase in Medicaid payments for primary care physicians. It promises them no less than 100 percent of the Medicare payment rates for 2013 and 2014 — but that’s no great relief. Medicare also pays significantly less than the private sector, and there is no provision for continued federal funding at those levels after 2014. At that point, either state taxpayers will have to fund significantly higher Medicaid expenditures or their Medicaid physicians will face huge pay cuts.

A second great concern among physicians is the power of the newly created Independent Payment Advisory Board (IPAB). Comprised of 15 unelected bureaucrats, IPAB is tasked with containing Medicare’s soaring costs by finding spending cuts that will meet budget targets specified in the Obamacare legislation.

The board is limited in how it can achieve its goal. The only real tool available is cutting Medicare payments even more.

As former Vermont Gov. Howard Dean put it, the IPAB is essentially a health care rationing body.

By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.

Obamacare’s expansion of government-financed health care, which further disturbs the doctor-patient relationship and disconnects patients from financing of care, exacerbates the very worst features of today’s health care system. It is a primary reason arguing for full repeal of this ill-designed law.

Alyene Senger is a research associate in the Heritage Foundation’s Center for Health Policy Studies.

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