Today on NPR:
"I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates. You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on," he says.The NPR piece goes on to describe how state healthcare officials are concerned about whether whether we might be headed toward a tiered healthcare system as a result of not enough doctors accepting the plans on the exchanges.
Three insurers offered plans on Connecticut's ACA marketplace in 2014 and Gerard is only accepting one. He won't say which, but he will say it pays the highest rate.
A few days ago I published a diary that seemed to foreshadow all of this. In the comments, I was told summarily that my complaints had nothing to do with the ACA, just the incompetence of private insurers. But maybe not so fast.
In a nutshell, I had my insurance company assign me to two different doctors in succession. In both cases, the company in question (Molina) believed that both these doctors accepted Molina Marketplace (the ACA Exchange plan). It turned out, in both cases, they were wrong, the doctors did NOT accept this insurance. In the case of the second doctor, Molina called the office to verify that they took the insurance, and were told the doctor did accept that insurance. Then, several weeks later, another rep was told they didn't.
At the time, I thought, gee, I hope there is nothing about the ACA that is making these doctors stop taking the insurance. Now, it's possible that they never took the insurance, and this was just an error on the part of the insurance company. But two days later, I hear this story on NPR, about doctors deciding they can't or don't want to accept the ACA plans because the rate or reimbursement is too low. It's possible that what I experienced is another instance of exactly this phenomenon: physicians cutting the ACA loose because the reimbursement rates aren't high enough.
Whether or not my story is connected to these developments or just a fluke, the ACA seems to be facing a challenge here: if it can't pay rates that make doctors want to accept it, those of us with insurance through the ACA are going to find ourselves, as the article says, with insurance, but unable to visit a doctor.