The United States of Affordable Care (Act)

Health Care Financing would seem to be a long way off from the patient waiting to see their physician.

In today's world the quantitiy and qualitiy of care depends very much upon the type of health insurance the patient has to use.   The care may be far different according to region, or state.

The term 'public health ' is a misnomer. The public health system is not accessible to all people for a number of reasons.  Many perceive public health as inferior to the 'private system of health care", and only would access a center if there were no other option. Many current users of public health and/or Federally Qualified Health Centers would not even know how to access ' private care'. Learn more about them here and here and  here.  I particularly like the last one. No one home --

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If you are successful, the rules are as long as the Affordable Care Act.

A new term which may be unfamiliar to most providers and/or patients is the "Federally Qualified Health  Centers".  These centers are found more commonly in areas of low economic assets and amongst many people who fall in the range of the Federal Poverly Level (FPL).  And here are the numbers which are both unrealistic at the lower end and even more unbelievable at the top end.

• $11,490 to $45,960 for individuals
• $15,510 to $62,040 for a family of 2
• $19,530 to $78,120 for a family of 3
• $23,550 to $94,200 for a family of 4
• $27,570 to $110,280 for a family of 5
• $31,590 to $126,360 for a family of 6
• $35,610 to $142,440 for a family of 7
• $39,630 to $158,520 for a family of 8

We seem to be an impoverished nation in the world of developed countries.

Many of these centers predominantly serve 'medicaid' beneficiaries. They also serve ( unintentionally) to isolate medicaid and those who are receivng public assistance from the main stream of health care.  Hospitals and providers also treat these patients differently, not so much in terms of the quality of care they receive....rather the accessibility.  Many budgetary decisions by states often effect Medicaid patients first, because large portions of state budgets are allocated to Medicaid.

There is a non-admitted  'caste' system when it comes to medical care.  It largely is secondary to income and location, and in cities there is often a sharp divide between those living in upper middle class neighborhoods and lower class neighborhoods.

The situation is also becoming worse, and there is no sign the Affordable  Care Act will diminish the divide.
Although the ACA specifies preventive medical care  (for free)  Despite being "free", there will be a cost. There are 14 general categories,   22 special categories for women, and 25 categories for children.

A disturbing distinction between public health and private health financing is also more evident with the introduction of health information technology. In order to qualify for Grants for Information systems and operational financing a non-profit status is a requirement, which immediately rules out most entrepenurial systems (ie, private fee for service office and/or clinics, as well as some hospitals.

WHY YOUR DOCTOR WON'T (CAN'T) SEE YOU NOW , AND HOW TO GET AROUND IT

October, November and December 2013 have been rough months for all Americans. The effects of the Affordable Care Act are having some predictable effects on our health system.  In addition to what has happened, unknown secondary effects are still boiling below the surface of health reform.

Many Americans are concerned about the viability and even the enrollment process for the Affordable Care Act.

Some of these patients will seek out alternative methods to obtain acute or even routine necessary health care.  Cash will become a new source for paying your doctor.

In the midst of the Obamacare fiasco, direct payment and concierge practices are an alternative, and perhaps a necessity to obtain health covereage, even for the short term.

For every great challenge there are also great opportunities, such as direct payment practice. However caution is a necessity.

CALIFORNIA: 70 percent of California doctors plan to boycott Obamacare exchanges

Many reputable neutral sources have reported, " About 70 percent of California’s 104,000 doctors are reportedly planning to stay out of the state’s health insurance exchange, a move that could have significant impact on implementation of the Affordable Care Act.  

This is not a 'willful" arbitrary decision on the part of these physicians.  It is a logical and sound business decision to remain fiscally viable and avoid insolvency. As states across the country work to enroll Americans in the ACA, one question that remains is exactly what kind of doctor access patients will have when their coverage kicks in. According to the president of the California Medical Association, Dr. Richard Thorp, residents there could find limited options at the start of the new year.

Thorp told the Washington Examiner the primary reason that seven-out-of-10 California doctors are boycotting the Obamacare exchange is due to the state’s low Medicare/Medicaid reimbursement rates, which typically land 30 percent below those in other parts of the country.

For example, Medicare typically pays doctors $76 for return-office visits, but in California doctors only receive $24. A tonsillectomy, meanwhile, pays out between $500 and $700, whereas doctors in California receive $160 for the procedure.

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

“This is so poorly designed that a lot of doctors are afraid to participate,” said Dr. Sam Unterricht, president of the 29,000-member medical society, to the New York Post.“There’s a lot of resistance. Doctors don’t know what they’re going to get paid.”  California’s Medi-Cal reimbursement rates have long been a sticking point for doctors, but when insurance companies revealed their rates would be tied to the state’s Medicaid program, many physicians balked.

This sign indicates the extreme distress the Medi-cal system will endure from ObamaCare in California.

To make matters more confusing, multiple medical association leaders told the Examiner that many of the doctors listed as participants in Covered California, the state’s insurance marketplace, have not stated they’d accept patients from the exchange.

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

“Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” Alex Briscoe, health director for Alameda County Health Care Services Agency in California, said to the Examiner. “There aren’t enough primary care physicians, period.”

Rob Lamberts M.D. a DPC physician offers his experience and advice to other physicians

RT, a popular online Russian news source reports the same information

If you want to know more about direct payment programs, and models consider reading Concierge Medicine Today

The content of this post offer opinions on both sides of the issues, patients and providers.