Wednesday, November 27, 2013

Fwd: qotd: Major physician organizations concerned about impaired access through exchange plans

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-------- Original Message --------
Subject: qotd: Major physician organizations concerned about impaired
access through exchange plans
Date: Wed, 27 Nov 2013 13:02:57 -0800
From: Don McCanne <>
To: Quote-of-the-Day <>

The Wall Street Journal
November 26, 2013
Doctors: New Health Care Plans Raise Red Flags
By Louise Radnofsky

Physicians groups told Obama administration officials Tuesday that they
are worried that new insurance plans under the Affordable Care Act offer
only limited networks of providers and low reimbursement rates for
doctors, and that could make it difficult for millions of those enrolled
to actually get health care.

As the Journal has reported, some health plans don't include big
brand-name health providers in their networks and are slashing how much
they'll pay medical practices for treating the newly covered.

Representatives from the major physician lobbying groups raised these
issues Tuesday in a White House meeting with health officials including
Chris Jennings and Jeanne Lambrew of the White House, and Chiquita
Brooks-LaSure of the Centers for Medicare & Medicaid Services.

"Some of the things were not a surprise to them… they're acutely aware,"
Shawn Martin, a top lobbyist for the American Academy of Family
Physicians, said after the noon meeting.

The American Medical Association, the American Academy of Family
Physicians, American Academy of Pediatrics, and American College of
Physicians, the American Osteopathic Association, the American Medical
Group Association and the American Association of Nurse Practitioners
were among the groups present, participants said.

Comment: The new health plans to be offered in the exchanges are
avoiding excessive premium increases by using narrow networks of
physicians and by lowering payment rates for health services. The
leaders of our nation's leading organizations of health care
professionals are concerned enough about what this might do to patient
access that they met with Obama administration officials at the White House.

The administration officials were already "acutely aware" of these
problems. Of course, they were. They result from fundamental design
flaws in the financing model of the Affordable Care Act. The model was
designed by and for the private insurance industry.

It is likely that members of these professional organizations are not
only concerned about the patients, narrow networks and lower payments
have a direct effect on their livelihoods. In a well designed system,
patients must always come first, but the professionals taking care of
the patients should be content as well. Grumpy doctors and nurses
detract from an optimal patient care environment.

There will be more discontentment as the Obamacare model of
high-deductibles, narrow networks, and payment restrictions extend to
employer-sponsored private plans. These trends will no doubt expand with
the proliferation of private insurance exchanges catering to employers -
exchanges outside of the government-operated Obamacare exchanges. Even
the private Medicare Advantage plans are being modified in response to
their overpayments being pared back. UnitedHealth, the nation's largest
private insurer, has notified thousands of physicians that they are
being dropped from their Medicare Advantage network.

Do we really want to keep headed in this direction?

The traditional Medicare program does not use narrow networks. Patients
have their choice of their health care professionals. Medicare payment
rates are higher than the rates expected to be offered by most of the
exchange plans. It would not take much to improve Medicare, and then it
would be an ideal program for covering everyone.

You can bet that the representatives of these professional groups didn't
ask for single payer to be put on the table. Too bad.

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