ACA Simply Not Working

A recent survey found that the uninsured rate in America fell from about 16% to 13% in the last quarter of 2014. For some, this is proof-positive that Obamacare is working, but nothing is ever so cut and dry.

The unemployment rate is slowly ticking downward, and since most insured obtain their health insurance through an employer, certainly this accounts for a portion of the decline in the uninsured rate. On the other hand, the Affordable Care Act must be credited with helping reduce the uninsured rate as well. The ACA is heavily subsidized, and human nature dictates that when you heavily subsidize something, more of the product is sold.

The main problem though is that saying that more people are, “insured,” does not mean that more people have access to care. 60% of the newly insured are enrolled in Medicaid, not private insurance plans like those offered through an employer or purchased individually.

Medicaid reimbursement rates to doctors and hospitals were increased for two years as part of the ACA to increase physician participation, but those rates have been cut by as much as 47%, effective 01/01/2015. Cut someone’s pay by half and chances are they may not want you as a client. As a result, the number of physicians accepting Medicaid patients continues to drop in large numbers. Less doctors, 20 million more patients, equals a crisis that will only get worse. If you have Medicaid, you are six times more likely to be denied an appointment as a new patient than those with private insurance such as Blue Cross and Blue Shield of Arizona. If you are lucky enough to get an appointment while on Medicaid, (AHCCCS in Arizona,) the average wait time is 42 days, which is double that of a private plan. And the news gets worse for Medicaid patients. The Inspector General of HHS recently sent out undercover agents posing as patients to doctor’s offices listed as participating providers in Medicaid. Over 50% of those listed were not at the address in the directory. Others were found but were not participating, while others were not accepting new patients. When the inspectors were able to set an appointment, wait times were a major issue. 28% of the appointments required a wait time of more than a month, and 10% more than two months.

Being covered is not the same as receiving care, and things will only get worse as more and more physicians and hospitals stop accepting Medicaid patients, and to a much lesser extent private plans, opting instead to offer concierge services.