In exchange for lower premiums, some of these insurers are offering “skinny networks” that give consumers more limited options for providers. “A primary objective in the marketplace is to offer the cheapest plan possible, and to do that the insurers are going to look at who are the least expensive providers,” said Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges. Not surprisingly, some of the costliest providers tend to take care of sicker or higher-risk patients.
Explore This IssueJanuary 2014
“It’s a very, very strong concern, and it’s one that we have been very vocal on since the enactment of the Affordable Care Act,” Mitchell said. The association also has expressed concern that lower-income patients buying into the cheapest plans may not have access to the specialty services they need the most. That possibility, she said, increases the importance of navigators helping the newly insured to pick out the best plans.
A Question of Access
Another big question is how the healthcare system will accommodate the influx of newly insured. “Coverage doesn’t equal access. That’s the big distinction,” said Dr. Boss. With bans on annual limits and pre-existing conditions, patients with chronic conditions may have more options. Conversely, many healthcare plans in the exchanges will require higher out-of-pocket payments, which could have the biggest impact on otolaryngologists and other doctors who provide more specialized services.
“As physicians, I think all of us are happy that more people will have insurance coverage and will thus not feel as restricted in being able to seek out care. I think in general that’s a good thing,” said Gordon Sun, MD, MS, an otolaryngologist and medical director at Partnership for Health Analytic Research in Beverly Hills, Calif. On the other hand, he said, doctors also understand that increasing the number of potential patients without significantly adding to the workforce will increase caseloads. “It doesn’t matter if you’re a primary care doctor or you’re a specialist. Everyone’s going to see more,” Dr. Sun said.
Mitchell said the existing provider shortage, almost evenly split between primary and specialty care, is already worsening due to the sheer number of baby boomers entering Medicare. At the same time, she said, one in three doctors in the U.S. is now over the age of 60 and nearing retirement age. Whether through Medicaid or the marketplace, the ACA’s coverage expansion will exacerbate the shortages. “It’s not to the level of the boomers entering Medicare, but it certainly is having a major impact on access issues, and exacerbating the shortage, again, across specialties,” she said.