ACA vs. AHCA: Readers Weigh In

Editor's note: We work hard to write about issues that will help physicians run their practices in a manner that is both prosperous and efficient, while still delivering quality patient care. And we are delighted when our readers let us know what they are thinking. This month, we excerpt a blog from an administrator regarding the stress of collecting at her practice. We also excerpted a practice rounds blog on physicians' reaction to Republican efforts to repeal and replace the ACA. The articles have been edited for space and are followed by comments made by readers at PhysiciansPractice.com.

AAFP, ACP Urge Senate to Halt AHCA

The American Health Care Act (AHCA) does not have many fans in the medical community. Among other things, the bill would replace the subsidies that the ACA provided for low-and-middle-income families with a tax credit, end the Medicaid expansion program in 2020, and increase the amount insurers can charge older consumers compared to younger ones from three times the amount to five times. The bill, passed through the House on May 4 by a vote of 117 to 113, has moved on to the Senate despite its critics.

James says: I am a 20-year physician who has worked in all realms. I am for the AHCA ....not opposed to it, as are most of the hundreds of physicians I know.

To also drive down costs & increase quality, the following must be destroyed (all dying anyway): 1. MACRA; 2. MIPS; 3. Meaningful Use, 4. Mandated EHR use (Especially PCPs); and 5. Overuse of "extenders" & artificial lines blocking competition between state insurance companies.

Pat replies: I agree with you. I don't know of any physicians who are for the ACA. It is a giant fraud based on lies. I don't know where they are getting the information that 20 million more people have affordable healthcare than before the ACA. Most exchange policies have ridiculously high deductibles of $6,000 for an individual and $12,000 for a family. In what world is that affordable? So people are still not able to go to the doctor because nothing is actually covered until they meet that deductible. Also, almost all the practices in my area are not accepting new Medicaid patients. Even if they find someone willing to accept that insurance, they are about 20 miles away and you can't get an appointment for months. So Medicaid members are still flocking to the ERs for non-emergency issues. I also see some Medicaid plans that reward people for going to the doctor! They even give patients tickets to sports events! Last time I checked, sporting events were not medically necessary!

Onyi says: The part of the AHCA I like most is the part where 24 million people who were insured and could get free mammograms, colonoscopies, annual physicals, preventative services, cheap meds, etc., will lose their insurance. It'll help people learn how to pull themselves up by their boot straps.

David says: Not sure how anyone can reasonably support ACA when it is imploding into a black hole where soon there will be no insurers willing to participate and therefore no insurance available to a large number of people. [The ACA is] not exactly fulfilling its goal of increasing the number of insured, except possibly for those on Medicaid funded on the backs of others. The new bill is openly considered a start to be modified in the Senate and then further after that. Obamacare took time, but obviously was doomed from the start, as many predicted. Let's give the Senate and House a chance to make it right rather than stay with a failing health plan.

Collecting from Payers and Patients Is Draining

I often credit my self-confidence and assertiveness to my Italian female elders who taught me to value myself enough to overcome any trepidation or fear of confrontation that I might feel. That said, I am aware that I can get loud, even shrill, when backed in a corner. And nothing gets my blood pressure higher than when payers and patients dare to delay payment or question the value of services delivered by my husband, the solo pediatrician I collect for. There is a great line in the film "As Good as It Gets" when Cuba Gooding Jr.'s character gets aggressive with Jack Nicholson and then regrets it, blurting out, "I hate doing this! I'm an art dealer." That's exactly how I feel when I hang up the phone with certain patients and insurance representatives (I'm looking at you Aetna). I'm a medical administrator, not a strongman, but sometimes I feel like if I don't lay down the law, I'm never going to get paid.

Lori says: It's hard...very hard…and I agree with Leann; Aetna is the worst! But Humana isn't far behind.

Mark says: My experience is that our patients are doing pretty well keeping up their part considering their high deductibles. I can't say that for all the insurance companies. We have found that in the last two months, our 31-60 day A/R has doubled. They truly are trying to put us out of business. As physicians, we are going to have to change the law. Medicare is cutting our throats right now in our practice. I don't think we have a sustainable business anymore. I'm making plans to get out of medicine that will take me three to five years to complete. I'm not sure I can make it that far. I'm all ears for solutions. I have found that there is no help out there for us little guys.

Leann replies: Thank you for your comment. We've noticed new delays in payment from insurance companies as well!

Depending on what state you practice in, your state's medical society can be helpful with passing legislation designed to protect small physician practices. We are in Massachusetts, which has an active medical society, but if I'm being honest, I wish our society was more like the one in Arizona. My understanding is that the Arizona Medical Association has successfully passed some of the best laws to protect physicians against insurance company shenanigans.