Connecticut’s doctors are closely watching the debate in Washington, D.C., over the future of the Affordable Care Act and attempts to overhaul the nation’s health care system.
The Connecticut State Medical Society, an organization that represents many of the state’s doctors, is unenthusiastic about the proposals that were proposed by Republican congressional leaders because they would have resulted in large numbers of new uninsured patients.
But Dr. Jeffrey Gordon, the president of the society and a practicing hematologist/oncologist at the New London Cancer Center, says Obamacare has serious problems too, hampering the practices of many Connecticut doctors with additional red tape and hurting patients who are facing escalating premiums and higher and higher co-pays and deductibles. But he says Congress should try to fix those problems and not scrap a system that has been in place for years.
When Congress returns from its summer recess next month, some Republicans hope to take another stab at a health care overhaul.
Gordon told the Connecticut Mirror he hopes the concerns of the nation’s doctors are included in the debate.
What are the fixes that need to be made, or does Obamacare need to be repealed? What do Connecticut doctors believe needs to be done?
I think you are going to find a wide variation of opinion based upon whether some doctors feel it should be repealed or replaced or it should be fixed. The Connecticut State Medical Society believes the Affordable Care Act is already in place, so the best thing to do is to try to deal with fixes instead of try to repeal the whole thing with a replacement that’s uncertain since Congress has been unable to come up with any agreement on what a replacement would be.
So the best thing to do is to try to deal with the program as is and fix it, that would cause the least disruption… especially for people who are in the midst of getting treatment for massive medical problems. You don’t want to cause disruptions in that.
How has the Affordable Care Act affected your practice?
I did initially see an increase in patients being able to get on to insurance. But, unfortunately over the last year I’ve seen an increasing number of my patients who are reluctant to use their insurance because of how much it’s costing them.
The proposals in Congress to replace the ACA have varied, but they all would roll back Obamacare’s expansion of Medicaid. Is that a good idea? It would save the states and federal government money.
The concern is that you had a lot of states that went ahead, jumped on the bandwagon and expanded Medicaid. And in Connecticut there was a prior decision to expand Medicaid, relying on federal money. Connecticut can’t afford to pay for the Medicaid expansion it agreed to, it already has a multi-million dollar deficit. So it’s very dependent upon federal money to keep it going. Realistically, there’s going to be a discussion on funding.
About 200,000 people in Connecticut were enrolled in the Affordable Care Act’s expanded Medicaid program, a joint-federal, state program that now covers more than 750,000 people in the state. What can be done if Congress does approve a bill that cuts federal Medicaid money to Connecticut?
What we’re hoping for is that people already on insurance not be suddenly thrown off of it; and number two, if there’s going to be a look at Medicaid expansion, it shouldn’t be to cut the money and have people be thrown off of it or cut the reimbursements to physicians.
I think there’s going to have to be serious thought about continuing to fund the program and look at more the levels of services that get paid for if there are concerns to the overall cost to the federal government. But right now, you already have people who are on it, physicians who have signed up to participate. So at a minimum, we don’t want to see any cuts to the Medicaid expansion program at this time.
There are other ways that Obamacare can be fixed in the interim, then you can pin it to some long-term ‘reality checks’ as far as how you are going to pay for things over many decades
So Congress should leave Medicaid alone, at least for now?
What I’m saying is ‘don’t do anything right now.’ I think it should be level-funded right now. Then you can pivot and say, ‘How can we cut this Medicaid expansion in the future?’ There’s no real plan for that right now…and that’s going to take some time to sort through as opposed to saying, ‘Oh let’s cut Medicaid expansion’ without a clear plan on how you are going to handle it. So I say, keep the funding as is, focus on these other needs to be dealt with … and then that gives you the time to sort out the long-term sustainability of the Medicaid program.
What are the kind of short-term fixes you think the Affordable Care Act needs?
Well, number one, it’s a very top-heavy program when it comes to rules and regulations and regulatory burdens. It makes it more difficult for physicians, especially those in private offices and in rural areas, including rural areas in Connecticut, to do what they need to do to take care of people.
There is a lot of what I consider extraneous and unnecessary reporting that has to be done that’s time-consuming and expensive. I think a lot of those regulatory issues that are not directly needed for patient care should be put on hold. The focus should be on shoring up the Medicaid expansion, because that’s where a lot of people have gotten their coverage from, and also try to get a handle on the skyrocketing premiums and deductibles and skyrocketing expenses that are really making it difficult for people to actually use the insurance they’ve enrolled for.
More than 25 percent of the patients that purchase insurance on the Access Heath CT exchange don’t get federal help in paying for their premiums, co-pays and deductibles. They are the ones who are really hurt because of rising premiums and high deductibles. Is this a concern for Connecticut doctors. Are these people getting the medical help they need?
I see this every day where people are enrolled in insurance in the Affordable Care Act and their premiums have gone up, so there’s more they have to pay, and their deductibles are very high, so they are reluctant – and some even scared – to use the insurance because they would have a lot of out-of-pocket expense.
And it does affect our ability to care for people. It’s a real issue. And that’s not something I’m suggesting is an easy fix. But it’s something that Congress and the states need to come together and find a solution to this. It’s one of the major problems of the Affordable Care Act.
It lists all these people who have insurance, but those numbers do not at all tell you what people are doing to use their insurance, and that’s a very sad statistic that more and more people are afraid to use their insurance because of how much they may have to pay out of pocket. We see that every day as doctors and that’s very much of concern for us.
What kind of ‘red tape’ has the ACA imposed on doctors?
When Obamacare went in, Congress enacted a whole bunch of additional and extra reporting measures where we have to report on all sorts of disease states and outcome states. A lot of things need to be done electronically, which is difficult for doctors who can’t afford electronic records, if you are in a rural area and you are a solo doctor. It’s a burden that consumes a lot of time, it takes time away from seeing patients and consumes a lot of financial resources.
Connecticut only has two insurance companies in their ACA exchange. Both of them say if they don’t get cost-sharing reduction payments – subsidies from the federal government that allow them to cut deductibles and co-pays for low income people – and hefty premium rate increases they will leave. So where does this leave the doctors? Are there concerns there will be a lot more uninsured as people who are now getting government help won’t be able to afford their coverage?
That’s a serious concern. It’s interesting on one hand that insurers are real quote, unquote ‘concerned’ about not getting what I call a bailout from the government. On the other hand, we’re seeing reports come out recently in news services that the insurers are making huge profits every quarter. So there’s a big disconnect there. That’s an issue that’s going to be addressed: What is driving insurance companies to say they are going out of the exchanges. Doctor’s offices can’t afford all of that uninsured care and it rebounds back to the states and the taxpayers to pay for it.
Congressional Republicans crafted Obamacare “repeal and replace” bills without the input of doctors, hospitals, insurers or other stakeholders in the health care field. Do you think new attempts to overhaul the nation’s health care system will include these stakeholders?
We’re the ones who know firsthand how to do the patient care and what needs to be done. We hope legislators, members of Congress, will listen to us, talk to us more as we all try to do what needs to be done to help people get affordable insurance and get the care they need.