By Paul Bremmer
Obamacare already has been blamed for the cancellation of millions of health policies that didn’t meet the government’s requirements and for raising the cost of medical care.
Now it appears to be sending more people to hospital emergency rooms. A poll shows three of four ER physicians is seeing an increase in traffic, some by significant numbers.
Supporters had claimed that more people would be covered with insurance, so they would be seeing their own doctors and not showing up as often at the ER.
But there is new evidence that emergency room visits have gone up nationwide under Obamacare, because it’s not just having a health policy that matters, it’s what kind of coverage it provides.
Dr. Lee Hieb, past president of the Association of American Physicians and Surgeons, explained.
“It’s a joke, because here’s what they did – they expanded Medicaid,” Hieb told WND. “Now, Medicaid isn’t really insurance. They pretend that’s insurance. Medicaid is bad coverage that doesn’t pay doctors and hospitals enough to take care of you. So if fewer doctors take Medicaid, people then go into the emergency room.”
A poll released May 4 by the American College of Emergency Physicians found 28 percent of ER physicians have seen large increases in patient volume since Obamacare took effect Jan. 1, 2014, while 47 percent have seen slight increases. Only 5 percent had seen a slight decrease in patient volume, and none had seen a large decrease.
The poll collected responses from 2,099 emergency room doctors and included representatives from all 50 states and the District of Columbia.
Tellingly, the poll also revealed 56 percent of ER doctors had seen an increase in Medicaid patients since Obamacare took effect. Only 1 percent reported any kind of decrease in Medicaid traffic.
Hieb, author of “Surviving the Medical Meltdown: Your Guide to Living Through the Disaster of Obamacare,” said the reason is simple: Medicaid doesn’t reimburse doctors and hospitals as well as private insurance does, so many primary care physicians have stopped accepting Medicaid patients.
She said this forces many such patients to seek routine medical care in the emergency room, which can’t turn them away. But Medicaid is not a good financial deal for the emergency rooms either, because in many cases they lose money on Medicaid patients.
“People that have real insurance have to pay to go to the emergency room regardless of what happens,” Hieb explained. “But if you’re a Medicaid patient, most states don’t charge you anything.”
She continued, “Real insurance means [insurance companies] don’t pay for every small-ticket item, you just pay for big catastrophes, and the patient picks up the cost of everything else.”
Hieb also pointed to another problem that may be leading to increased ER use: The nation is facing a shortage of primary-care physicians.
She said primary-care doctors are overtaxed and overregulated to the point where many conclude the practice is not worth it anymore. Hieb revealed that her son, who recently graduated from medical school, realized he couldn’t go into family practice because he wouldn’t earn enough money to repay his student loans.
“When the cost of doing business exceeds the cost you get paid, you’re just not going to do it,” Hieb reasoned.
What’s worse, Obamacare is expected to increase the number of patients primary-care physicians must treat, but Hieb says such an increased workload is not financially viable when many of these new patients possess government insurance.
“We’ve reached a point already where doctors simply cannot see more patients,” she said. “They cannot expand, and yet their payment’s being cut because now they’re expected to take these basically no-pay Medicaid patients. So they’re shutting their doors to Medicaid, and there’s already a shortage of family practitioners.”
Hieb believes the uptick in ER visits could start a ripple effect that would bring the U.S. medical system down.
“These people are going to start going into emergency rooms – emergency room physicians are not going to be able to make ends meet, and they’re going to demand salaries from the hospitals in order to be there,” Hieb said. “The hospitals have to have an emergency room in order to keep their accreditation, so they’re going to have to pay these guys more, and the hospitals are going to be financially strapped and the whole system’s going to collapse.”
Hieb has a simple solution to the problem of ER overuse: add a small surcharge. She claims that, when she was in the Navy, they had a $3 surcharge for ER use.
“When it costs you more to go to your emergency room than it does to go to your doctor, you’ll take a little inconvenience and wait a little bit to go see the doctor,” she said.
Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons, offered similar ideas for discouraging ER use.
“Send patients a bill – and insist on partial payment in advance,” Orient suggested. “That would mean changes in federal law (EMTALA) and Medicaid policy, which often does not require or allow co-payments. Also encourage direct-pay practices in which physicians are readily available. Instead, the ACA and other government policy is driving doctors out of independent practice.”
Unfortunately, 58 percent of physicians in the ACEP poll said their state or community was not actively trying to divert Medicaid patients from the emergency room. And 70 percent claimed their emergency departments are not prepared for further significant increases in patient volume.
They may see further increases in patient volume if more private insurance companies meet the fate of Assurant Health. The Wisconsin-based company announced last week it will either be closed or sold after losing tens of millions of dollars over the past two years.
Assurant Health, which was founded in 1892, told its shareholders it lost money because of a reduction in recoveries under Obamacare’s risk mitigation programs and increased claims on the ACA’s 2015 policies.
The company sat on the sidelines during the first Obamacare open enrollment period but sold plans on exchanges in 16 states beginning with the second open enrollment period. It also sold policies to individuals in 41 states and small businesses in 34 states.
In spite of the attempts to sell to more consumers, Assurant lost $64 million in 2014, and it reported operating losses of $80 million to $90 million during the first three months of 2015.
Another likely factor in the company’s huge losses was the end of underwriting. Before Obamacare, Assurant would underwrite its customers’ policies, allowing the company to adjust the price of a premium based on such things as a patient’s age and medical history. But Obamacare prohibited medical underwriting, which Hieb thinks was a foolish move.
“Underwriters have certain criteria,” Hieb said. “If you’re going to take away those criteria and say everybody’s got a right to everything regardless of anything, well, they’re not going to insure you.”
The collapse of private insurance companies like Assurant could drive more consumers to government insurance, which could then drive them into emergency rooms as primary care physicians can’t or won’t see them. Not to mention the effect it might have on other insurance companies.
“It will probably put a cool dampening on anybody wanting to get into the Obamacare exchange business,” Hieb said.