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The Doctor Won’t See You Now

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By Joel Zinberg

Millions may get “insured” through Obamacare, but that doesn’t mean they’ll be able to see a physician.

Proponents of the Affordable Care Act (ACA) insist that the law will extend health insurance to millions, expand access to health care, and improve Americans’ overall health. But, as the New York Times recently reported, at least 20 percent of the new enrollees have not paid their premiums. They therefore do not really have insurance. But even for those enrollees paying premiums, having health insurance is not the same thing as getting good health care, or any health care. In fact, it doesn’t matter how many Americans obtain insurance under the ACA. Most will have difficulty finding a physician.

Many Americans could lose their employer-provided insurance if firms decide that paying the ACA penalty—and maybe giving small raises to their employees—is cheaper than offering health insurance as a benefit of employment or reduce workers’ hours (the ACA does not mandate coverage for part-time employees). These newly uninsured workers will either have to enroll in Medicaid, if their income is low enough, or purchase a plan on one of the state and federal insurance exchanges. Those eligible for exchange subsidies may end up better off economically as their premiums will be so low, but both the exchange and Medicaid options are fraught with problems.

States are already struggling under huge budget deficits from their existing Medicaid programs. Since states lose federal funding if they adjust their Medicaid eligibility guidelines, their only option for reducing deficits is to cut already-low Medicaid reimbursement rates. Physicians are already reluctant to treat Medicaid patients under current rates that are a fraction of private and Medicare rates. Cutting reimbursements will exacerbate the physician-access problem and could lead to closures of so-called “safety-net” hospitals that care for many of the poor and uninsured. These hospitals have long depended on federal Disproportionate Share (DSH) payments to offset the cost of caring for the uninsured. But the ACA severely cuts DSH payments on the assumption that the uninsured will gain either Medicaid or private insurance. If large numbers of patients remain uninsured, safety net hospitals’ financial difficulties will be compounded by their obligation to provide uncompensated care.

Read more: City Journal

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