In the latest scare tactic used and repeated over the last week is that doctors are going to refuse to accept Health Insurance Exchange policies. Reince Preibus said that to Chris Jansing Friday morning and she was clueless on how to challenge this bogus argument, but not other arguments. This idea that doctors won't accept these policies is a talking point parroted by Congressional members hell bent upon derailing ACA. It's an old saw and it's wonkish to parse out the argument. That said, "Doctor's refusing to accept ACA Exchange policies" is a threat summed up in one word, hogwash.
That ship already sailed. Health insurers had to fulfill a requirement within the ACA that each policy had an "adequate provider network". So, this argument that doctors won't accept ACA policies is one year out of date. The physicians, hospitals, diagnostic centers and more have already seen the reimbursement fee schedules and signed up to take these insurance policies.
This isn't a new rule (pdf), it was published in the Federal Register 2012. NCQA the "deemed authority" agreed to change their accreditation standards. If health insurers wanted their policy to be accepted by the NCQA, and be accepted on the Health Insurance Exchange they have to comply with the "adequate network standards" (which is written in English, here (pdf)).
It's a statement full of buffalo feathers that I've detailed out below, however, if you want to skip to the story's end? Priebus is spouting balogna.
After working in health care for a long time, you get used to hearing health care providers complain about low reimbursements. That's what we call it, "reimbursements". Those are the monies the doctor or hospital receives after successfully sending in an insurance claim on your behalf. We've heard doctors are refusing to take new Medicare patients, refusing Medicaid patients and now they are going to refuse to take ACA exchange policies. Will some doctors refuse to take ACA policies? It's a firm, "It depends".
Physicians have always been able to decide what insurance companies they will accept and which ones they won't and these decisions are based upon the insurer's fee schedule. Doctors are also allowed to say if they will or won't accept new patients under a specific plan. The reality is that there will always be a curmudgeonly provider who won't take a policy that another physician is willing if not eager to accept. If you live in a urban area there will be a good selection of doctors. In rural areas maybe not, but that's not new either. HPSAs (Health Provider Shortage Areas) are a problem under Medicare and physicians in that area receive extra funds for Medicare patients. Private insurers have similar programs. Will physicians drop out of the provider networks for ACA Exchange Policies? Only when their contract with the Insurer allows it and then, another provider is highly likely to take their place.
Health Exchange Policies Aren't Readily Identifiable
Health insurance policies issued via the exchanges won't have a "Scarlet Letter" branding them as an Exchange policy. It will be more subtle than that. They are individual policies that won't have a Group Number on them, but that's it. As I wrote earlier this week about 15 million people have individual health care policies. They are small business owners including accountants, lawyers, doctors, architects and independent insurance agents. It also includes small retailers, electricians, plumbers and anyone else who doesn't have employer provided insurance. A physician who says they will not accept Health Exchange policies will be likely to turn away good paying patients. That's not something any decent healthcare administrator would advise their client physicians to do. The only way a physician would know if the insurance policy is an "Exchange Policy" is if the patient says it is. The anti-discrimination aspects of the ACA further complicates this position.
Some healthcare administrators are unsure how the Civil Rights Section 1557 of the ACA is going to play out or how it will impact decisions surrounding what insurances to accept. How the health exchange policies will work out is yet to be seen. The only remedy open to physicians is to opt out in toto and that's what the physicians who declined to sign contracts the Health Exchange Insurer Networks did.....months ago. However, if the doctor has a contract with United Health Care that renews in 2015 and United has exchange policies; the physicians won't be able to opt out of those patients. As a practical matter, the doctor won't be able to reliably segment out Health Exchange patients.
Section 1557 is the civil rights provision of the Affordable Care Act. Section 1557 prohibits discrimination on the ground of race, color, national origin, sex, age, or disability under “any health program or activity, any part of which is receiving Federal financial assistance … or under any program or activity that is administered by an Executive agency or any entity established under [Title I of ACA]….” Section 1557 is the first Federal civil rights law to prohibit sex discrimination in health care. To ensure equal access to health care, Section 1557 also applies civil rights protections to the newly created Health Insurance Marketplaces established under the Affordable Care Act.
Section 1557 is consistent with and promotes several of the Administration’s key initiatives that advance prevention and wellness, reduce health disparities, and improve access to health care services. The Office for Civil Rights in HHS is responsible for enforcing Section 1557 with respect to covered programs. The law was effective upon enactment and OCR has been accepting and investigating complaints under this authority. If you believe you have been discriminated against on one of the bases protected by Section 1557, you may file a complaint with OCR. OCR also addresses Section 1557 in conducting outreach and providing technical assistance to covered entities and consumers.
Any provider or health plan that is receiving payments under a government program has to comply with this directive. This includes any physician receiving payments for medical studies, pharmaceutical studies, federal grants or those who accept Medicare, Medicaid, Tricare, SCHIP, FECA Black Lung patients. It also applies to health insurers who receive the subsidies people receive on the Health Insurance Exchanges who will have to enforce this measure in their provider contracts. If past experience with HIPAA is any indicator, the Office of Civil Rights will issue directives for Corrective Action for a few years before they impose sanctions for violations. Until then, look for people to error on the side of prudence.
The Health Insurance Exchange policies already have their doctor and hospital networks set up. The contracts are signed. They are ready to go. If you want to know if your doctor is on the list, call them and ask. Meanwhile, my original assessment stands. That's hogwash.
2:02 PM PT: Thanks for the rescue. I just got back from a meeting. I need to take care of a couple things before dinner, so I'll be checking in and out.