Wednesday, March 16, 2016

A Primer for Armstrong & Getty's Doctor Panel Tomorrow

I'll be out of the office, on the road with spotty cell, but I've provided the team with some backdrop and statistics to help make their time with the doctor panel more fruitful.  As you listen to A&G at 8:00 AM PST tomorrow, think about the below facts.  You can listen online here.

IBD Update on Obamacare:
  • The Urban Institute estimated that 24 million people would be eligible for exchange subsidies this year. 
  • The CBO had projected that an annual average of 15 million people would receive subsidies this year, but last month it cut that estimate to 11 million. 
  • The data released by HHS suggest that 10 million or fewer subsidized customers will hold policies once payments are submitted, and that number is likely to dwindle as the year progresses.
The lack of enrollment from last year’s 11.7 million signup total is sending a jarring message. Consider that HHS pushed enrollment this year by saying most people qualifying for subsidies could get a plan for $900 or less this year. So why would people risk throwing out a nearly equal sum of cash on a penalty? The message is that people are simply too stretched to pay that much for a very-high-deductible plan. If the government is going to collect from them at tax time in 2017, they’ll worry about it then. 
As insurers continue to have their earnings pressured by the individual exchange business, and as the backlash over the individual mandate builds, it will increasingly become evident that the individual exchanges can’t be sustainable.
Overview on Medicare and Medicaid Reimbursement Rates

Medicare, which provides health coverage for seniors, pays doctors, on average, about 80 percent of what private health insurance pays. However, Medicaid, which provides health coverage for the poor, pays a much lower rate, about 56 percent. Source: Forbes
Other Quick Hits

California Doctors Have Serious Problems With Covered California Plans' Inadequate Reimbursement Rates - reimbursement rates are 20 percent to 40 percent lower than traditional plan rates

Cost-Shifting: The Hidden Tax Employers Pay to Compensate for Government Underfunding in Medicare and Medicaid (& Now PPACA), Study - In southeastern Wisconsin, cost shifting is responsible for 35 percent of the overall commercial rates paid.

Nevada's Medicaid Expansion Has Led to Double the Enrollment and Two Month Wait Times in Reno - Now it can take two months to get a doctor’s appointment at a local community health center, or an all-day wait if you just show up.

5.8% (or $14.4 Billion) of Medicaid Payments are Improper. 57% of Those Are Basic Human Errors

Medicaid Pays Below What It Costs To Take Care of Patients - He said Medicaid reimbursements are 22 cents to 25 cents on the dollar compared to what it costs to take care of a patient. Since office overhead alone is 30 percent to 50 percent, it puts a lot of pressure on doctors to stop accepting patients on Medicaid.

A great table showing how little Medicaid pays even in comparison to Medicare (which is only about 80% of employer plans). In California Medicaid only pays 51% of what Medicare pays (only 43% for primary care). Table shows all 50 states.