Physicians on the Front Lines Answering ACA Patient Questions

When the opportunity to talk to Lisa Zamosky, the consumer health columnist for the Los Angeles Times and WebMD’s health insurance expert about educating the public on the Affordable Care Act arose, the chance to get her take on the physician’s role was welcome.  

Lisa is smart, articulate, well-informed, engaging, and earnest. She is going to be an excellent ambassador for the ACA, and it’s a big job. Kaiser Health’s estimates that 125 million Americans are unaware that the ACA is law and is already being implemented and more than 100 million people will have to “reconsider” their health insurance coverage in 2014 (as in get it or replace employer coverage that went away).

I asked how important a role she believed physicians would need to play in filling the information gap. The response: “…while public education will help, primary care providers will play a critical role in educating patients.”

That led to the inevitable question on who is going to educate the providers.

“Understand the basics of the law,” she responded, “…have phone numbers and websites for the state exchanges” on a handout. And maybe add a list of the “free” services. A description of the new rights to insurance, and so forth would be nice, too.

If only things were that simple.

My guess is that Ms. Zamosky never met the Mrs. Lanskys of the world – with a single niece – you two would make such a nice couple, and are they taking my Medicare away? What should my children do? Little Walter, such a disappointment, he can’t afford a haircut let alone insurance. Is he going to jail?

Adding some meat to the handout, the important message, according to Zamosky, is that, while health insurance is expensive, most people should be eligible for help from the federal government. At the state levels, the Health Insurance Exchanges are the place to go to determine eligibility for and amount of benefits. The state department of insurance is another a resource, and, there will be online resources and numerous consumer-assistance programs - including the IRS.

I observed that touting the elimination of pre-existing condition restrictions, fully covered diagnostic screenings, and well visits that can be purchased for cash at deep discounts, and guaranteed access to a health plan at the same cost as sick people all seem to be more compelling reasons not to buy insurance until it’s needed.

Ms. Zamosky correctly counters that open enrollment addresses that concern, sort of. This year, it’s October through January. Next year and subsequent years, the enrollment periods contract.

If you get sick outside of enrollment, “you are out of luck until next year.” Ms. Zamosky advises us to pass that message along to younger people, and especially their parents, particularly mothers -- that and the vast majority (of millenials) will qualify for assistance.

True, all except for the “out of luck” part. Legally, the ED has to see and care for people, insurance or no, so it’s business as usual, and low odds to get caught on the short end of the boo boo.

Ms. Zamosky reluctantly agreed that it will take time, and that estimates of upwards of 30 million people will remain uninsured may be in the ballpark.

And that’s where physicians are at the pointy end of the situation. Pointy ends, actually, because on one hand hundreds of patients will be asking what to do and, on the other hand, others will elect retail clinics to handle most of what they need because they disclose prices and care is conveniently accessible.

This leads to “consumer-driven healthcare,” where, insured or not, people are paying out of pocket except in a catastrophe. “Retail clinics are a huge draw for people,” Ms. Zamosky points out, “you know what you are getting and there are no surprises.”

Not until that nasty, hugely expensive thing that wasn’t caught at the Quickie Clinic in the supermarket next to the magazine rack rears its head.

But, hey, open enrollment’s just around the corner…so, no worries.