How Will Obamacare Affect Podiatry?
- Volume 27 - Issue 1 - January 2014
- 15286 reads
- 6 comments
Now the reason you are hearing about premium increases and individuals losing their coverage as plans dropped them is because the plans did not meet the criteria of coverage listed above. If you consider that everyone will be paying increased premiums to provide coverage for these additional services, the only way the insurer can be profitable is to reduce the size of certain networks and charge greater deductibles on these plans.
As I previously mentioned, patients earning less than 400 percent of the federal poverty level would possibly be eligible for tax credits. What this means is some patients who are under a certain income level would receive subsidized premiums but may pay more in out-of-pocket expenses with increased deductibles. Early reports have deductibles around $6,000 for individuals and $12,000 for families.1,2 I learned that the out-of-pocket expenses will include items that were not covered before such as pharmacy costs, etc., so the idea is the patient will reach these out-of-pocket levels sooner.
The insurers’ point of view is that because of the ACA, more people than ever before will have access to health insurance, thus adding increased numbers of insured individuals. Since there are no preexisting condition restrictions or lifetime maximum limits under the law, insurers feel we will be able to get greater access to these patients than we were before.
There is a threshold of coverage under the law that requires insurers to spend 80 percent of every premium dollar on actual care and refund providers if providers pay any greater amount. What I feel this actually means is in order to not go over the threshold, payments to providers will be reduced. In fact, the new networks forming under these exchange plans will receive a level around 60 to 70 percent of Medicare with smaller panels of physicians. We are already hearing of doctors getting deselection notices from plans in certain markets. One thing I can say for certain is doctors contracted as individuals will be terminated before doctors who are contracted in a group. Those of you who know me know that I was the developer of the original podiatric supergroup back in 1994. I believed the group concept was viable when managed care began and believe this even more now.
Out of the four available plans offered — bronze, silver, gold and platinum — the insurance companies are leaning toward the silver plan. According to some high level insurance executives, under the silver plan, the insurance company pays the co-insurance that the patient normally pays. In turn, the federal government reimburses the insurance company. The interesting thing about this is according to statements made by Congress, there is no mechanism to accurately determine how much reimbursement the insurers should receive so these payments are to be estimated and accounted for at a later date.
Pertinent Insights On Potential Problems With Health Care Reform
So what could possibly go wrong with this scenario? The feeling among insurers is we should be very happy with this arrangement since there is less that doctors would have to collect from the patient because the co-insurance goes directly to the doctors. What they fail to mention is the deductible will likely be higher so, in reality, we will probably have to collect more from the patient.
Patients can get information about various plans directly from the insurance company sites but can only get subsidies through the government Web site. Since the cutoff date for January 1, 2014 effective coverage was December 23, as this issue went to press, it is unclear how everyone would be able to obtain coverage with the government Web site not performing optimally. (As this issue went to press, uninsured patients would not face a penalty if they registered by March 31.) The reason the premiums are reportedly higher for younger patients is the ratio of premiums between young, healthy patients and older, sicker patients has gone from 7:1 to 3:1, which does reduce the costs for the older patients but increases the premiums for the healthier patients. This is also why you are not seeing a lot of younger patients signing up.