Medical Profession Challenges in 2016

IMG_1266 1000pxThe Affordable Care Act is far reaching in how it has affected the healthcare industry.

Some are critical of it while others praise it.

Let’s take a look at how people are looking at its impact on the medical field — the doctors, dentists, ophthalmologists and surgeons — and the newly-insured patients.

The ACA is by far the biggest revolution in the medical world since Medicare was passed in the 1960s.

First, under the ACA more procedures and services are covered, as well as more people. No longer can health insurance companies deny coverage to people with pre-existing conditions. The ACA created “essential health benefits” that must be covered by health insurers. Every year you are entitled to an annual physical. These “essential” benefits include mental health, maternity care, drugs, rehabilitative therapy and chronic disease treatment.

The medical field is seeing the advantages and disadvantages of Obamacare.

One big plus is that doctors are seeing patients now who previously could not afford to get medical treatment. Before the ACA, people with pre-existing conditions were denied coverage unless they were in a group plan. These people could have needed a dental surgeon or an oncologist to treat their problems.

Of course, depending on the health plan people are on under Obamacare, money still can determine whether they choose to receive medical treatment. If you have a deductible of $5,000 and don’t have the money for a medical procedure, the insurance still isn’t helping. But if it gets you to see the doctor because the co-payment is only $25 it does help.

Depending on who you believe, the ACA increased the number of people covered totaled 13-14 million in 2014 with another 4 million in the first part of 2015. Another estimate is 22.8 million newly insured people which is decreased by the nearly 6 million people who lost coverage. Net number of people getting covered came to almost 17 million people. There are probably lower estimates out there, too.

The Kaiser Family Foundation reported the number of uninsured non-senior people in the country totaled 32 million in 2014, which is down from 41 million a year before.

To the critics of the ACA who like to point out that companies have ditched their group plans because of Obamacare, the Kaiser foundation reports that the number of uninsured people increased during the first decade of this century because fewer companies were offering group plans. People also lost their insurance during the Great Recession when they lost their jobs.

A lot of news articles reporting about the companies that said they were dropping health insurance because of Obamacare, but this trend had started decades before. Now, the companies were able to shift blame from themselves to the ACA.

With such an increase in the number of people insured it certainly was going to have an impact on the medical field.

That meant that more people were going to look for primary-care physicians. I don’t know about you but when I received my Obamacare policy I had to look for a new doctor (which has never bothered me). I found a lot of doctor offices on the plan who said they were not taking on new patients. Even my old doctor’s office refused me at first because I had been gone for two years, but eventually I got back with him.

As a result, health insurance companies have had an all-out push to enroll more doctors into their network. Another new factor that doctors have to address is payment plans for their patients. With high deductibles and maximum out-of-pocket expenses, more and more patients will have to pay for their medical care first out of their pockets before the insurance companies start picking up the tab.

You do get the benefit of the negotiated discounted rates from your medical care providers, but you still have to pay a lot of it yourself. For some of these plans, you are better off looking at them as a safety net if you you need catastrophic coverage.

That is why I always look for a plan that allows me to visit my doctors with a small co-pay before the deductible kicks in. Some ACA plans, specifically the bronze-level ones, require you to meet the deductible, which can be like $5,000, before they start paying for almost anything. One healthcare service that is always covered is the annual physical (to game the system, if you change plans in the middle you get to have another physical at no cost. Take advantage of it if you have any chronic problems).

There are a lot benefits coming out of the new healthcare law, and a lot of challenges, as well for both doctors and their patients.