What does it mean for the future of Obamacare if 83 percent of physicians surveyed say it makes them think about quitting?
Even before the Supreme Court upheld the law, experts were forecasting a massive shortage of physicians in the United States within the next few years, fueled mostly by an aging workforce. How will affordable care look when no one is around to provide it?
Well, hang on a sec.
The Doctor Patient Medical Association Foundation released a survey this week that contained the 83 percent figure. It’s gotten some play nationally, but it’s hard to know exactly how representative the figure is. The group sent survey questions in faxes to 36,000 physicians in active clinical practice. Only 16,227 of them were actually delivered, and of that only 699 completed surveys were returned.
I’m guessing the doctors who were upset by the Affordable Care Act were most likely to fill out the form and return it. So, with a 4.3 percent response rate and 83 percent of those people saying they are thinking about quitting … well, it puts things in a little different perspective.
Which is not to say doctors are thrilled with the new law or the thought of having to provide care to many people when, as the chair and co-founder of the organization said in an op-ed piece this week, they “can’t afford to see patients at the lowball billing rates.”
The Affordable Care act guarantees everyone insurance, not care. Don’t expect 8 of every 10 doctors to toss their stethoscopes and head for the door, though.
But a different angle on Obamacare is more interesting. While most people focused on the Supreme Court’s ruling regarding the individual mandate (which requires everyone to get insurance or pay a “tax”), the court also ruled that states cannot be forced into providing health care exchanges, which the law says should be set up to provide a marketplace in which consumers can shop for insurance.
The ruling also said states cannot be coerced into paying for an expanded Medicaid program.
Texas Gov. Rick Perry this week sent a letter to Washington saying his state isn’t going to do either of those things. Several others states are expected to do the same.
Washington will create health care exchanges for those states that won’t do so, but an argument has arisen over whether the federal subsidies to help poor people buy through these exchanges (amounting to $6,000 per person) apply only to state-run exchanges.
The answer to all this probably lies in the Department of Health and Human Services’ reply to Gov. Perry. “We will continue to work with states to ensure they have the flexibility and resources they need to implement the Affordable Care Act,” it said in part.
What the court did, then, was to give considerable leverage to states, especially big ones like Texas. President Obama has hinted that the law may need tweaks and changes. Expect states to have a big hand in that.