Just over two years ago, President Barack Obama signed the Affordable Care Act (ACA), a law purported to increase access to health care and to “bend down” the health care cost curve. A great debate over the implications of that law, especially in the areas of coverage, affordability, and quality of care, has arisen. Furthermore, a series of political and legal challenges have generated uncertainty about the law’s prospects within the health industry and at the state level. Despite this, the Department of Health and Human Services (HHS) has already issued over 12,000 pages of regulations elaborating on the original 2,700-page law, leading to more uncertainty regarding how appointed and career federal officials will determine the exact shape of the law’s final requirements. All of this uncertainty raises real concerns about how the new law will impact the most crucial actors in any health care reform effort: doctors.

Doctors are demonstrably nervous about the new law and how it will affect their incomes, their access to technologies, and their professional autonomy. According to a survey by the Doctors Company, 60 percent of physicians are concerned that the new law will negatively impact patient care. Only 22 percent are optimistic about the law’s impact on patient care. Fifty-one percent feel that the law will negatively impact their relationships with patients. These statistics raise questions about how and whether doctors will participate in the new system.

From an economic perspective, the Obama health law has reduced the number of available options for finding additional budgetary savings to pay for the Sustainable Growth Rate (SGR). The law would impose planned annual reimbursement cuts of over 20 percent on doctors, and further challenges the prospect of fixing the SGR. In its promise to cover an additional 32 million Americans, the Obama health law will grow the Medicaid rolls by 16 million. Medicaid reimbursement rates are lower than those doctors get from privately insured patients. Consequently, imposing these lower reimbursement rates on a growing number of patients will only exacerbate access issues in the future.

Physicians also worry that the new law will interfere with their practice of medicine by shifting decision-making authority from doctors to government officials. The establishment of strict guidelines that prevent doctors from making decisions based on their personal interactions with patients, known as “uniformity of practice,” is a long-standing concern. Yet, a number of provisions in the new health law, particularly the Independent Payment Advisory Board (IPAB), bring the prospect of committee-based medicine much closer to reality. This 15-person board will be charged with controlling Medicare spending by making payment and practice decisions that will oftentimes tie doctors’ hands. Similarly, the $10 billion Center for Medicare and Medicaid Innovation gives the HHS secretary and the CMS administrator enormous power not only to experiment with new payment and delivery systems, but to impose the results of the experiments without external verification.

Reactions to these new constraints could vary. Doctors could choose to create boutique practices and demand cash from patients up front in order to avoid dealing with government or insurance companies. Others will depart from individual practices and join larger groups, particularly hospitals, which have more leverage with insurers and more staff to handle the increasing paperwork burdens. According to a report by Accenture, this is already happening: the percentage of doctors owning their own practices is dropping, and expected to continue dropping, from almost half in 2005, to 43 percent in 2009, and to a projected one-third in 2013. Under the ACA, however, this trend may intensify.

Another concern is whether certain doctors, in light of the bureaucratic constraints and rejiggered economics of the new law, would continue to practice at all. Given the looming physician shortage, there is not a lot of room for error. As the Association of American Medical Colleges noted, by 2020 we will already need 91,500 more doctors than we are projected to have — 45,000 from primary care and 46,500 surgeons and specialists.

The ways in which the administration interprets the Obama health law will have far-reaching implications for physicians and their patients. Many of these changes, while worrisome, are predictable, and government officials and health care administrators can prepare for the expected consequences. Many others, however, are less predictable, including the possibility that the supply of doctors will not be able to meet the demand, or that dedicated professionals will lose the incentive or flexibility to create new cures, or that talented individuals will choose not to pursue medical training at all. If these outcomes occur, we may never know what the ultimate consequences might be, and who will be left waiting for the treatment or the cure that never comes.

Another concern is whether certain doctors, in light of the bureaucratic constraints and rejiggered economics of the new law, would continue to practice at all. Given the looming physician shortage, there is not a lot of room for error. As the Association of American Medical Colleges noted, by 2020 we will already need 91,500 more doctors than we are projected to have — 45,000 from primary care and 46,500 surgeons and specialists.

The ways in which the administration interprets the Obama health law will have far-reaching implications for physicians and their patients. Many of these changes, while worrisome, are predictable, and government officials and health care administrators can prepare for the expected consequences. Many others, however, are less predictable, including the possibility that the supply of doctors will not be able to meet the demand, or that dedicated professionals will lose the incentive or flexibility to create new cures, or that talented individuals will choose not to pursue medical training at all. If these outcomes occur, we may never know what the ultimate consequences might be, and who will be left waiting for the treatment or the cure that never comes.

Click here to download Tevi Troy’s The Secretary Shall: How the Implementation of the Affordable Care Act Will Affect Doctors as a PDF.

Tevi Troy is a Senior Fellow at Hudson Institute and served as the Deputy Secretary of the U.S. Department of Health and Human Services from 2007 until 2009. This article was published by The Daily Caller and is reprinted with permission.

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25 Responses for “How The Affordable Care Act Will Affect Doctors”

  1. bob says:

    how is this any different from insurance companies restricting treatments so they can profit?

    • MrNeedtoKnow says:

      The difference is that the government will make the profit and not the insurance company that provide jobs and tax revenue for the government.

  2. BobbyG says:

    Y’know, I’m with Joe Flower on this one. See

    http://www.imaginewhatif.com/healthcare-futurist-supreme-court-cant-stop-healthcare-reform/

    I’m now reviewing Dr. Toussaint’s new book “Potent Medicine.” A lot of the same riffs.

    “dedicated professionals will lose the incentive or flexibility to create new cures”

    Not everyone is driven by the profit motive. In particular the best of the lot.

  3. VaneSanc says:

    It is different because insurance companies can’t put restraints on your right to freedom. President Obamas Affordable Care Act taxes people 2.5% of their income but only gives free health care to the lower class citizens. On top of that if you do not purchase health care you may be fined up to $12,000. Most lower class citizens are living off unemployment and while I am aware that we are in the middle of an economical crises I also know that there are jobs out there. They might not be top paying jobs but it is a job. Laziness is crippling our country. I also don’t think its fair to doctors, which most are sitting on hundreds of thousand of dollars of debt due to school, to have to be restricted as to what course of treatment they may take with their patients. I’m sure Obama had good intentions going in but I think this is a terrible plan.

    • J.R.Reynolds says:

      “Laziness is crippling our country” What data do you have to support this claim? Productivity has skyrocketed in America, worker efficiency has also, yet pay has stagnated for those “lower class citizens” for thirty years! Here you are sympathetic to Doctors who are being treated “unfairly” if they have slightly less lucrative reimbursements, yet you think people who can’t find work are “lazy” for not taking low-paying jobs? That is ludicrous. America’s “problem” is that the top 1% now take more than any time since 1928, up top 24% of total wealth. Workers, far from being lazy, aren’t being paid for their hard work and so haven’t shared in the profits they created. Add to that reduced taxes and bailouts for failures at the top, and the resultant income disparity means that the Demand sector of society hasn’t got the resources to buy things. Alas the plight of the poor wealthy people, how unfair it is they have to suffer the complaints of the poor they trod upon. Can’t we provide them earplugs?

      • Chris says:

        Just look at the labor participation rate. The number of people growing dependant on government assistance. That should be enough data to support his claim. Your response/opinion is obviously a bias one. I can tell by what you wrote that you vote for and defend your party no matter the wrongs it commits. In your eyes, they could do no wrong. Lemming.

        • Mike says:

          How many million jobs were off shored again? You are intent on your preconceived notion and refuse to see multiple issues. You know it all, but understand little.

          • Chris says:

            You brought up the offshoring as if it’s a phenomena. There are 3 reasons why offshore has grown attractive to corporations. Of course you wouldn’t dare mention that the regulatory and compliance cost for any business would have anything to do with it. Or how about a depreciating currency? Of course not, you love big government and without a central bank buying up our treasuries you wouldnt have regulatory agencies to fund. It obviously wouldn’t sit well with your dogma. Oh and the third one is greed. :-) Good day.

        • Mike says:

          There is also a giant tax advantage to ship a job overseas. Tax advantages hurt our citizens for the benefit of a very few, I got no dogma, Homeboy. But again you have all the answers. Enjoy your delusional approach to issues, its your by god right. You are still viewing issues through a small hole, but its your right. Lemming? Seems appropriate for you. Yeah that living on government assistance is such a great life, I’m sure many reach for that goal. Sorry for your lack of understanding, but its mostly willful on your part. I’m out!

          • Chris says:

            No response, not even an analysis of the situation. Simply parroting the same bs as the MSM. Insinuations is all I got from your rhetoric. You’re merely describing the symptoms and willfully ignoring the cause of it. Ignorant voter you are I bet.

      • Tisosy says:

        J.R. Reynolds, extremely well said! Thank you for this enlightening post.

      • J. Ricci says:

        @ J.R. Reynolds: Well said.

      • Judianne says:

        The problem is not slightly reduced reimbursements. It’s vastly reduced reimbursements coupled with increased costs of doing business and extremely expensive federally mandated changes to medical practice, such as EHR’s which do not, as you were probably led to believe, have the ability to communicate with other doctors or hospitals. They communicate only with insurance companies. We are now seeing twice the number of patients than we saw a year ago and are being reimbursed less than a third of what we were at that time. Just to pay his workers and keep his practice afloat for the benefit of his very sick patients, the physician now never gets home any earlier that 1:00 AM each morning, and this is seven days a week with no break. If you think this is safe for either you or your healthcare providers, you are VERY POORLY EDUCATED as to the physical and mental need for sleep and down time. There have already been larger numbers of healthcare workers who have been killed in traffic accidents and who have succumbed to suicide as a result of this increased stress and sleep depravation. How would you like the government to walk in and take over your profession, making changes such as these that would affect you in this manner? How would you like to be demonized by insurance companies and entitled feeling members of the general public and told that your education debts were your problem, since you were stupid enough to incur them knowing that you could have pursued a different path? Oh, no … that would never happen to you! You’re too smart for that! Don’t hold your breath, honey. This is only the beginning in the continuing saga of how to break the backs of the working public.
        You are right about one thing, for the most part, working people are not lazier. In fact they’re working harder than they ever have. However, to counter balance that effect, we also seem to have more freeloaders full of feelings of entitlement than we ever have before. Well, here’s a news flash for you and them. No matter how loud you holler, you will never have “free” healthcare. Even if the government or the insurance companies enslaved every single one of us, you would pay for the privilege in one way or another, if not in several ways. In fact you would undoubtedly pay more than you ever did before, because unbridled greed answers to no one and nothing … especially not the Hypocratic oath!

      • Ellis says:

        Spoken like a true Democrat!

  4. marilyn says:

    When you speak of a lower class citizen who are you referring to? We have one class of citizens. It’s called an American Citizen. So, evidently if you are speaking of a lower class citizen you must be referring to yourself.

  5. there is some anger says:

    VaneSanc, your statement and choice of words indicates a complete lack of knowledge of how social systems work in the U.S You realize that unemployment is collected by people who have recently lost employment? And that to maintain unemployment benefits one has to actively search and apply for employment? You might be thinking of SSI (supplemental security income), but the few who are able to “milk the system, soley living off of ~$600 a mo. per individual is a far cry from the billions of tax payers and investors dollars lost to shotty big business practice (not to be assuming you’re a fan of big business). And I have no idea where you are getting the $12K figure you’re quoting. It should comfort you though that your defined “lower class citizen” is not going to be guaranteed coverage. The major safety net of this plan was the Medicaid expansion to cover people within 133% of FPL. But now since USSP ruled that Medicaid expansion is in the hands of the States, and since many State Governors are bigots and do not have their constituents’ interests in mind, you’ll see big states like Texas (which stands to benefit the most from this expansion!), Florida, Louisianna, ect. deny life saving measures to their poor, their unlucky, people who have lost their jobs, houses, lives to what ever illnes afflicts them, in favor of playing to politics, and the ignorany notion that the poor are poor because they are lazy. I’ve talked to to many people who have lost everything due to chronic conditions such as cancer, multiple schlerosis, ect. They were hard working Americans, and once they got sick, the system was broken for them. Your statement is appaling.

    • Sam says:

      When one refers to the ‘poor’ you do realize that of a level that most US working class citizens’ can’t fall into. Poor is not basic cable, an ‘obamaphone’, a 97′ accord, a one bedroom apartment. We create this idea of poor and the race, ethnicity and social structure of whom appropriately plays the role of poor and whom takes the blame. Until this is society is viewed as a fair game- which it is not, this script will continue to be played on repeat. This the 1% such propaganda when you think about it. How is it fair that you can take 39.8 percent of someones equally earned pay? How this is supposed to be equality for all. Is the health of the 1% factored in, the people living in the house? No. It doesn’t matter, just the number matters not the unique situation given to the individual. Once you’re above that margin, it doesn’t matter. How is it right that the majority of working class US America receives not one entitlement when they provide all the funding? How is that EQUALITY? The ones that receive the benefits are the actual 1%. The issue is many of liberals believe economic crisis is one that is caused by societies infringement on ‘minorities’ and their needs and capabilities must be tended to with emotional rationale , it is time to view things with logic and reason! This is the United States of America. You are what you make of yourself, not what you expect to be given to you. The business is not the problem, it is those that.

  6. Jenn says:

    Most of those living in the lower class are not lazy but are working. Unfortunately jsut becuase you have a job doesn’t mean it can provide all that you need in terms of food, housing, and healthcare. For those that have worked, were laid off, and now are diagnosed with cancer…but have no health insurance…..what about them??? Are they lazy now that they are getting treatments and can no longer work ? Does a job at McDonalds really going to help cover the chemo cost ? Those that think everyone on welfare or get assistance do nothing all day should be ashamed of themselves. I know a lot of people who have relied on public assistance to help them thru a tough time. Healthcare should be provided for everyone !!!

  7. Mike says:

    What is in the ACA that would allow insurance companies to reduce compensation to physicians? I have invested in a single physician’s private practice. He and business manager are telling me insurance companies are slashing payments to them, by 40 to 50%. . I just want to know the truth. Thank you

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