Positives
Business is better for providers as more patients are in the system. This means more consultations and procedures, and thus more revenue for hospitals.
In 2010, 60% of patients without health insurance didn't seek care due to cost. Now that the uninsured rate is lower, we would expect these individuals to seek more care.
For the most part, doctors can keep their patients (this issue is normally phrased as, "can patients keep their doctors?"). However, if a patient is on a plan that is no longer deemed suitable in Obamacare, then the patient must get a new plan which has a new network. That could result in some loss of patients for a doctor.
In addition, Medicaid payments have been brought to parity with Medicare payments in states that have expanded Medicaid. The increased Medicaid payments are funded by the federal government, and are intended to make it more attractive for providers to treat Medicaid patients.
Primary care doctors and general surgeons who practice in medically under-served areas will also receive a 10% bonus.
Negatives
Not all hospitals are setup to handle the influx of new patients, and that has resulted in lower quality of care for patients.
Also, as mentioned above, some patients might not be able to stay with their doctor if they have to change their plan.
However, most physician complaints relative to the new payment system that the PPACA institutes:
- While Medicaid payments have risen in states that expanded Medicaid, Medicare payments will be reduced in some situations as more payments are "bundled". Bundled payments are intended to create incentives for quality treatment at lower cost.
- A further action to control Medicare spending is the creation of the Independent Payment Advisory Board (IPAB), a 15 member board that looks to cut costs in the Medicare system without affecting coverage or quality.
- In addition to the IPAB, the PPACA has facilitated the creation of the Relative Value Update Committee (RUC). This is a private group of 31 specialty physicians who can advise on how to value a physicians' work.
- Both the IPAB and RUC could be perceived by physicians as excessive bureaucracy affecting their practices.
- Physicians also complain that hospital payments have risen 35% over the last 10 years, while physician payments have only increased 3%.
- Perhaps the most troublesome provision of PPACA is the need to provide care for patients even if they haven't paid their premiums. An estimated 20% of patients sign up for an Obamacare plan and don't pay their premium and lose their coverage after 90 days. In that 90 days, they often seek treatment, but it doesn't get paid for. The onus is placed on physicians to determine who has paid their premium. This aspect, or loophole, of the PPACA is the primary reason why 2/3 of doctors don't accept Obamacare plans.
- Physicians also complain about the administrative burden placed on them with electronic health records.
- Also, as PPACA removes a small portion of funding to hospitals that have higher re-admittance rates for Medicare patients, some providers will be negatively impacted as they treat more challenging patient populations.
Net
Physicians largely support or oppose Obamacare based on their party affiliation. Clearly, more patients in the system is good for business. However, Obamacare care increases administrative burdens and changes the payment scheme to providers. However, overall, the net effect seems to be positive for most providers' businesses. Claims of 'death panels' seem exaggerated. Yes, the government is playing a bigger role in how physicians are paid, but as they are collecting taxes to fund Medicare and Medicaid, they have every right to rationalize the payment system.
Sources:
Do Doctors Loathe Obamacare?
Obamacare Doctors
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