Skip to main content

Obamacare 2016: Success or Failure?

September 7, 2016

Obamacare 2016: Success or Failure?No matter your political persuasion, there’s enough available data to make the case either way. The law’s proponents point to the uninsured rate of 11%, the lowest in over eight years, and down 6.1% since Obamacare’s individual mandate took effect. 

Opponents, on the other hand, have plenty of data to support their claims that the law is a failure. Soaring insurance premiums, up as much as 76% in some cases, give lie to the law’s promise of “bending down the cost curve.” In addition, overall national health care spending reached an historic $3 trillion in 2014, the most recent year figures are available, up over 5%, after remaining relatively stable for many years. Prescription drug expenditures grew an astronomical 12.2% in 2014, several orders of magnitude greater than prior years’ increases of just 2%. 

Perhaps more ominously, growth health care expenditures is expected to outpace GDP by nearly 2% year over year from 2015 through 2025. Currently, health care consumes about 17.5% of GDP; by 2025, that figure is expected to exceed 20%. Even with its own conservative estimates, the Centers for Medicare and Medicaid Services predict that Obamacare expenditures will account for nearly half of all national health spending by 2025. By its own parameters, these figures suggest the law has failed at least in its promise of lowering overall health care costs. 

But what about consumer choice?

Another feature of the law promoted by its supporters was that it would expand choice and increase competition; again, however, the data suggests this has not occurred. 

The Obamacare state health insurance Consumer Operated and Oriented Plans, or CO-OPs, once hailed as a cost-saving alternative to state exchanges, have failed at an alarming rate. There were 23 such state CO-OPs during the first Obamacare open enrollment period in 2013 but today, only seven remain. It’s uncertain whether the remaining few will survive the next round of new enrollments, even with an aggressive push to secure outside investments. Generous mandated benefits, an unfavorable risk pool, competition from commercial carriers, and risk corridor shortfalls all contributed to the CO-OPs’ demise. 

Those who purchase insurance on the Obamacare exchanges are faring little better. According to research by the Avalere Consultancy, one third of Americans will have just one option on the exchanges in 2017, and 55% of Americans will have two or fewer choices. In fact, the research discovered there are some areas where consumers have no options in the Obamacare exchanges. 

Related Article: 5 ways Obamacare can improve medical practice’s reimbursements

Obamacare and the Private Practice Physician

When it comes to the bottom line, however, private practice doctors seem to be feeling the pinch the most. AthenaHealth released troubling data that most private practice doctors already knew: Obamacare is costing them an average of $50,000 per year in top line revenue. It’s not just the administrative and regulatory burden, although obviously that’s a major part. What’s really affecting most private practice doctors is the change in patient mix and reimbursement rates. 

In many cases, Medicaid is the culprit. In 2013, when open enrollment went into effect and many states expanded the Medicaid program, just 15% of an average practice’s patients were on Medicaid. In 2015, that number exceeded 20% for states that expanded the program. In addition, the number of commercially insured patients dropped from 66% in 2013 to just 62% in 2015. Add in Obamacare reimbursement rates, which are much closer to Medicaid than Medicare, and the aggregate hit for the 40% or so of doctors currently in private practice comes to about $18 billion per year in lost revenue. Perhaps it’s no wonder, then, that just one in three doctors are estimated to remain in private practice by the end of 2016. 

Whether you’re on the success side or the more pessimistic failure side, there’s no doubt the law has changed coding and billing protocols for private practice doctors. If you have questions about Obamacare and your revenue cycle, contact the billing experts at M-Scribe for a free billing analysis today. 


Get the Latest RCM News Delivered

Receive practical tips on medical billing and breaking news on RCM in your inbox.

Get in Touch