ACA enrollment ends, but law still has unanswered questions for providers

The Obama administration says that 7.1 million uninsured Americans now have health insurance through the Affordable Care Act’s (ACA) health insurance exchanges which ended their first enrollment period on March 31. However, it is still unclear how the influx of millions of new patients will affect healthcare’s gatekeepers-primary care physicians (PCPs).

A last-minute push for enrollees included multiple media appearances from President Barack Obama, Vice President Joe Biden, and U.S. Department of Health and Human Services Secretary Kathleen Sebelius, all mostly encouraging “young invincibles” to sign up for health insurance. In January, young adults accounted for about 25% of all ACA enrollees.

In the past month, state- and federally-run healthcare exchanges have enrolled close to two million people, not counting the expected uptick of enrollees in the last few days before the deadline.

There has been concern about the number of people who are technically enrolled in an ACA plan, which is marked by payment of premiums. White House officials say that 80% to 90% of those who have enrolled online have paid, which is close to insurers' estimates. Analysts say it could take months to know the exact number of people who are signed up for insurance through the healthcare exchanges.

Demand for primary care

With an increasing demand for the services of PCPs, and a dwindling number of practitioners, it may take years to understand the effects of the ACA on small practices. And having insurance doesn’t guarantee that patients will have access to healthcare. Recent studies show that patients are waiting longer to see family physicians, up to 66 days in Boston, for example.

Physicians have faced scheduling and cash flow issues due to the influx of new ACA patients since the beginning of 2014. Practices are taking additional time to verify insurance for patients who have yet to receive identification cards for new policies, causing workflow delays.

Next: 90-day grace period, high-deductible plans strain doctors

90-day grace period challenges

The ACA’s 90-day grace period provision also puts practitioners at risk, as patients are allowed to float payments for up to three months, and resulting in physicians having to collect directly from those who are dropped from insurance plans for non-payment. The American Medical Association (AMA), and several other physician advocate groups, have repeatedly argued that insurers should be responsible for payments during the full 90-day grace period, rather than physicians.

“The grace period rule imposes a risk for uncompensated care on physicians so the AMA has created resources to help medical practices navigate the key aspects of the rule to minimize its potential negative impact,” said AMA President Ardis Dee Hoven, MD. “Managing risk is typically a role for insurers, but the grace period rule transfers two-thirds of that risk from the insurers to physicians and health care providers. The AMA is helping physicians take proactive steps to minimize these risks.”

High-deductible risks

As millions more join the healthcare system, often with high-deductible plans, many physicians worry about patients’ risk for non-payment. Most of the new insurance plans being sold on insurance exchanges will be in the “bronze” category-with higher out-of-pocket costs, according to a report in the August 2013 issue of Health Affairs. Experts have suggested that physicians use lines of credit, upfront payment plans, and other forms of special financing to brace for the onslaught of payment and billing hiccups as new patients begin to flood primary care practices.