It seems like a no-brainer, but the Affordable Care Act, designed to get everyone covered by some kind of health insurance to pay for some level of healthcare may actually end up highlighting the different quality and access to healthcare people receive based on income. The reason is that the ACA creates no requirements for physicians to participate in health insurance programs or face a tax, only that individuals participate in health insurance programs or face a tax.
While the individual tax is new, the option for physicians that they not participate in health insurance plans has always been the case. But with cost-cutting objectives included in the plan, many physicians have “promised” that they’ll opt out, not only from Medicare and Medicaid but from any insurance plan at all.
In October of 2012, this issue was recently addressed in an article entitled, “When Doctors Stop Taking Insurance,” by Roni Caryn Rabin, in which the issue of “cash-upfront” medical care is addressed. You can search for the NY Times article by its name.
In addition to all the publicity about physician shortages, the trend of greater numbers of physicians not participating in health insurance plans means that healthcare for the rich will remain virtually unchanged while healthcare for the poor will involve longer delays, and less choice of physicians.
Within the Affordable Care Act’s requirements of different levels of insurance using metal names from bronze to platinum, there will be a secondary market of medical care, outside the world of insurance that will be available only to the rich. Based on current information, there will be a growth in this secondary market outside of Affordable Care.
Ultimately, it is the consumer who can help influence whether the vast majority of citizens will have access to quality healthcare. Consumers should shun healthcare providers who don’t accept insurance in favor of those who participate in insurance plans. Encourage state licensing boards to add the requirement that physicians participate in at least one or several insurance plans in order to be licensed in your state. It’s a purely financial play and a purely financial response is appropriate. If consumers are answered with threats that people won’t become physicians, then let that happen too, after all, most of us can’t afford physicians who don’t take insurance.
And it’s not only physicians who are encouraging an expansion of the great divide. The Affordable Care Act has already contributed to a revival of tiered provider networks where consumers pay more in terms of “cost sharing” for providers outside the insurance plan network. So, while fewer physicians participate in any insurance plan, providers reduce the amount of coverage individuals get in the form of contributions for expenses for using physicians outside the plan’s network.
In terms of the fiscal cliff, this aspect of Affordable Care and the expansion of better healthcare options available to the rich who can afford to pay physicians in cash, should incentivize every citizen to support the removal of tax breaks for the wealthy because in addition to the false idea that jobs have been created by these wealthy Americans, providing additional cash for the rich to create their own healthcare system works directly against the interest of any American who cannot afford healthcare without health insurance.
We’ve all been asked to suck it up and put up with adjustments including proposed cuts to “entitlements” because of our country’s financial state, for the greater public good. A continued false idea of capitalism that allows the rich to pressure the government through lobbying or manipulate politics through contributions or even diminish the pool of healthcare services available to the common folk who rely on health insurance should at some point start to offend the vast majority of citizens who live in this country.
