<p>Add to this that since the Bronze plans are the most affordable they will be popular. These have high deductibles…so wouldn’t a provider be a bit concerned if a subsidized patient (who else would go through the exchange) comes in with a high deductible plan. It’s human nature to wonder…how will they pay.</p>
<p>Really, if you were trying to provide for your family by going to work as a physician…would you want to risk your financial well being?</p>
<p>^^^Sorry to bore you…it’s exhausting to leave one’s own echo chamber.</p>
<p>If you look at the graph, the average difference between bronze and silver deductibles is $1776. The average silver deductible is still $2567. So, if a subsidized patient is already subsidized, how secure are you they will be able to come up with the co-pays and deductible amounts?</p>
<p>Tpg (and LasMa,) that quote was from healthcare.gov and dated in early December. </p>
<p>do you currently have insurance I had the same issue, tpg, some confusing question from my own state exchange. It was one of those that really needs a help button explanation.</p>
<p>As for medicaid reimbursement, you really have to separately dig for medicaid reimbursement discussions for background, context, and how reevaluations have been handled to date. It can’t effectively come into discussion without that. I’d call it a different hot button, in that respect. Already under it’s own steam. </p>
<p>But why on earth would ANY physician’s practice accept patients whose reimbursement schedule- a little matter of the Hippocratic oath, I might guess. </p>
<p>Well, all right, let’s look at this problem, and consider what the risk of doctor-stiffing is. Consider patients on the exchange. They are, mostly, fairly low income-- we know this because the vast majority are getting subsidies, and subsidies only go to people with incomes less than 400% of poverty. So we might think they are more likely to stiff their doctor. But they are mostly buying Silver plans, and Silver plans have lower deductibles, particularly for the lower income people where deductibles and copays are subsidized. So that would make them less likely to stiff their doctor.</p>
<p>The scenario for stiffing your doctor involves your getting treatment, not paying for it, and dropping your insurance. Risky. If you think you might need more treatment for your condition, you’d be better off coming up with the insurance payment. I’m not saying that no one will do the doctor-stiffing scenario, but I am saying that it probably won’t be rampant. However, some people will stiff their doctors, and doctors should probably be protected against it. Not sure how that could be enacted, but I suspect a reasonable solution could be come up with.</p>
<p>Now let’s consider the people off the exchange. They are more likely to be buying Bronze. But we know that off-exchange buyers have incomes greater than 400% of poverty, or they would have bought on the exchange to get subsidies. Someone who is above 400% of the poverty level has money, money that collection agents can go after. I’d say doctor-stiffing would be less likely in the off-exchange population, because the off-exchange population has more to risk.</p>
<p>I looked at the chart about deductibles for various metal levels. It is based on Avalere data. I chased down the Avalere study. When computing the deductible for Silver plans, Avalere seems not to have considered the deductible subsidies that many people with Silver will receive. </p>
<p>“This, predictably, caused an adverse selection death spiral, as more and more healthy people opted out of buying insurance and premiums got higher and higher.”</p>
<p>Which is why the mandate is so important and why the individual mandate was one of the cornerstones of the Heritage Foundations plan and the 1993 Chaffee plan. </p>
<p>“Subtitle F: Universal Coverage - Requires each citizen or lawful permanent resident to be covered under a qualified health plan or equivalent health care program by January 1, 2005. Provides an exception for any individual who is opposed for religious reasons to health plan coverage, including those who rely on healing using spiritual means through prayer alone.” </p>
<p>It is remarkable to read the Chaffee plan and compare it with ACA. It is, for all intents and purposes,the same plan. </p>
<p>There was also no subsidy from NYS - which is another big reason for the failure of the individual market here. In my opinion both an individual mandate and subsidies are required for it to work. </p>
<p>Dietz199, Where do you get the info that doctors lose money on medicare patients? Do doctors actually lose money or do they make less with meficare patients?</p>
<p>I like this link. Looks like in aggregate doctors will make billions more with the bump up in medicaid rates. That is good for doctors. This increase in rates means that doctors who take medicaid patients will see increases in pay. The increase in medicaid reimbursement makes it more likely doctors will see medicaid patients. That is good for medicaid patients.</p>
<p>But does anyone here even know what dollar amounts are- and how it actually correlates to cost of services? After salaries (physicians’ being the highest,) cost of equipment, goods, space, etc, my impression is these practices are not operating as “close to the bone” as simple statements imply. I asked this before and don’t remember a reply.</p>
<p>That means 1.2% more Americans, 3.8 million people, are insured than in December. And more people are still signing up for health coverage. This is old data. The interviews were done Jan. 2-Feb. 28, 2014.</p>
<p>“But a big obstacle for Medicaid patients has always been the Medicaid program’s lower-than-Medicare reimbursements. Blackwelder points out that on average Medicaid pays only about two-thirds of what Medicare pays, though this varies from pre-existing parity in a couple of states (Alaska and Wyoming) to as little as one-third as much, in Rhode Island.”</p>
<p>That is addressed with ACA for 2014. Now… This should be extended.</p>
<p>Every doctor is not going to jump and now take medicaid patients. Many dont take medicare patients. However, some doctors will take medicaid patients and these doctors will be reimbursed billions more in aggregate.</p>
<p>I dont know why Gallup is using dates that include early Jan. </p>
<p>Texaspg… There are going to be another 150,000+ signups in NY. More people are going to pay.</p>
<p>We read only 2 million are paying; therefore Obamacare is a failure. 3 million are paying. Etc.</p>
<p>It is kind of silly to read these comments in the press. The sign up period is not over. There are going to be more sign ups and more people are going to pay. </p>
<p>Humboldt County and the rest of the North Coast of California are thinly populated. The insurers are going to have to budge on reimbursements, if, as seems to be the case, they don’t have enough providers for their subscribers. But apparently, the problem up there is there aren’t enough doctors. The old solution, of allocating doctors to people of means and having poor people just not go to the doctor, is not one that I care to endorse. </p>
<p>I wonder if some primary care docs from the Bay Area (where we have plenty of primary care docs) are going to decide to move up to the North Coast. It’s gorgeous up there, and the cost of living is way lower than it is in the Bay Area. </p>
<p>But can those Bay Area doctors get by on 65% less salary? Maybe if they take up Humboldt County’s biggest industry as a sideline. (For you out of staters, I’m refering to growing marijuana). </p>
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