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The Next Obamacare Tragedy

Stanley Feld M.D.,FACP, MACE

Late in the afternoon March 25th  the Department of Health and Human Services announced that it is extending the enrollment period for Obamacare to April 15th from March 31st.

“The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health plans through the federal insurance marketplace by the March 31 deadline.”

Those who are going to apply have enough time to apply in seven days if the website and the navigators are working correctly.

It sounds as if enrollment figures are not good.

“Under the new rules, people will be able to qualify for an extension by checking a blue box on to indicate that they tried to enroll before the deadline. This method will rely on an honor system.”

“The government will not try to determine whether the person is telling the truth.”

This is not a very good way to run a business.

The next tragedy in the implementation of Obamacare is providers’ participation in the Affordable Care Act. There is so much uncertainty in the Obamacare that many physicians and physician groups have opted out of participation in Obamacare.

In California, independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting Covered California, the state health exchange.

Dr. Richard Thorp, president of the California Medical Association said,  “It doesn't surprise me that there's a high rate of nonparticipation,” 

The CMA represents 38,000 of the roughly 104,000 doctors or 20% of the physicians in California. Dr. Thorp said nothing about the California Medical Association doing a study to determine the percentage of physicians who are not participating in Obamacare.

However the Daily Kos ranted about the Washington Examiner story not being true.

“The latest right-wing disinformation campaign, all over the far-right media is that 70 percent of California's doctors are boycotting Obamacare. Is it true? Of course not. Is anything the Washington Examiner, WND, or Breitart publishes true?”

However the Daily Kos did not offer any facts about what is true.

It is a typical Alinsky disinformation tactic. You must freeze your enemy and then criticize and discredit him.

The LA Times reported in December that the state exchange Covered California reported,

In fact, according to Covered California, the only source with verifiable numbers, some 58,000 doctors, or more than 80% of the state's practicing physicians, will be available to enrollees in the exchange's health plans.

First of all, 58,000 physicians are not over 80% of California practicing physicians, if the 58,000 number is true. It is 55.77% of practicing physicians.

“Covered California says that the doctors participating in its exchange plans include 100% of Kaiser Permanente's 14,000 California doctors, 43,000 taking HealthNet patients and 35,000 in Blue Shield's network. (There's probably some overlap between the latter two networks.)”

The twisting of the facts is the method of operation.

On February 7, 2014 the LA Times reported Covered California admitted there are many errors in their physician directory.

“Admitting Covered California gave some consumers bad information, California's health insurance exchange pulled its physician directory for having too many errors.”

It appears that Covered California was not a very good source for the LA Times and Daily Kos to quote. Both media outlets called the Washington Examiner story a right wing lie.

Covered California made the move late Thursday amid growing frustration among both consumers and doctors over inaccurate information about insurance networks in the state marketplace.”

California patients are discovering that their physicians are not participating in Covered California. Some have discovered that they are not covered by healthcare insurance coverage at all because of computer glitches.

The exchange previously yanked its online directory of medical providers in mid-October after acknowledging there were serious problems then with the data. It published an updated list in November.

The updated list at that time still had some serious problems. The list misled consumers into signing up on the exchange. Covered California is bragging about the number of people they have signed up.

California is supposed to be the star of the state exchanges. Yet they had to close down the exchange in February for repairs and updates. The federal government gave the state exchange an additional $155,000 million dollars to fix the exchange. This is not a small amount of money for a “superb exchange”.

Here are some facts from practicing physicians.

In September 2013 insurance companies disclosed that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. This is contrary to the Daily Kos claim that the physician fees are negotiated.

Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor is quoted as saying, “In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24,.” “In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160.

It is logical that physicians in California would say no to the state exchange, Covered California. No matter what lies the spin masters use the facts are the facts.

Physicians say, “We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,”


California physicians have protested that the Covered California's website lists many doctors as participants when they aren't. This is false advertising.

“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.

Donald Waters, executive director of the Alameda-Contra Costa Medical Association said. “They may be listed as actually participating, but not of their own volition”.  

Waters said. He called the exchange's doctors' list a “shell game” because “the vast majority” of his doctors are not participating.

 “This is a dirty little secret that is not really talked about as California promotes Covered California”.

Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego said, last summer she "got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying les.s

 They did not tell me how much less. You had to agree or disagree. So, of course, I said no."

Covered California expects 85% of the physicians in California to participate. So far they have made these statements to the press but have not published any proof of participation.

 Covered California asks physicians to participate but does not disclose the reimbursement rates they will pay for participation in Obamacare.

Other state exchanges’ are also in trouble. Oregon and Connecticut are the most outstanding.

This is only the beginning of Obamacare’s provider problems. It is too bad that America is afflicted with this albatross at this time. Obamacare is destroying the healthcare system for consumers and physicians.

President Obama will not be able to charm his way out of the failure of Obamacare.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone

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