A candid Q & A with Elson M. Haas MD
Q: So, Dr. Haas, now that we are several months into the Affordable Care Act, what is your assessment from a provider’s point-of-view?
A: Well, so far as I can tell, no one’s very excited about the ACA (“Affordable Care Act”), including me, my associates, and my patients. Many are paying too much for poor coverage.
Q: Not excited? Why is that?
A: It seems that insurance companies are now covering less, including fewer doctors on their plans and being subsidized by taxpayers in the process. Many are paying more for an inferior product; we don’t like that in America.
Q: If that’s the case, what are the consequences at your clinic?
A: The first thing we noticed was that our reimbursements for the new plans are reduced by about 30-40 percent for our patient visits. As you can imagine, this has had a huge and negative impact upon our clinic operations. We also noticed that a number of our patients who were previously covered found out that they were no longer covered when they came to us for care.
Q: Your patients who were previously covered found out that they weren’t able to see you anymore and be covered by insurance!? How did that happen?
A: Good question—the only thing we know is that I was, and am an Anthem Blue Cross provider (for example), and when my patients who were previously covered by this plan moved to Covered California they found that their plan was now being managed by another company with very few doctors involved, and my name wasn’t on the roster. And we had no communication from Anthem about this.
Q: Is this an isolated situation?
A: No. We have had a number of patients come into our clinic and find out to their surprise and dismay that they are no longer covered. So the impact is multiplied—we don’t provide care, the patient doesn’t receive care, and we don’t get paid. I don’t think that’s what the authors of the ACA had in mind. The only thing that seems to be working is that the insurance carriers are being paid handsomely for providing less coverage.
Q: This sounds like a very critical situation. What do you see happening in the months ahead?
A: We wish we knew. We certainly can’t continue to operate under this broken system, especially since I feel primary care doctors using the insurance model were being underpaid before the ACA took effect. It has been challenging enough being reimbursed for the level of integrative and preventive care we provide with little consideration for the time and effort we invest on our patients’ behalf above-and-beyond the visit. This includes phone time, prescription re-fills, weekend calls and more. The only thing I can see is that if we are going to remain solvent as a clinic, patients are going to have to pay more and more for these services which were previously covered.
Q: Dr. Haas, what message do you have for patients who are currently involved with the ACA?
A: I would ask anyone covered under the ACA—in California or elsewhere:
How is it working for you?
What has been your experience so far?
What suggestions do you have to make insurance better?
I would also encourage people to read my previous blogs about this matter, in which I promote an approach where we as individuals assume a greater responsibility for our health through preventive care and healthy lifestyle choices, and keep our “insurance” focused on coverage for catastrophic events and serious injuries.
If you have thoughts you would like to share with Dr. Haas about the ACA, please leave comments below.