Affordable Care Act
Posted: November 15, 2013
While the federal government computer experts attempt to work out the glitches with the Healthcare.gov web site, it is apparent that the Affordable Care Act (ACA) is going to impact health care delivery in many other ways. For example, a study in the Annals of Family Medicine journal predicted that the country will need 52,000 more primary care physicians by 2025. Most everyone will be affected by this statistic, except for those who passed the law in the first place.
Most of the extra doctors are going to be needed because of the projected population growth. But the problem also begins with training - only one in five graduating medical residents plan to go into primary care, according to the Journal of the American Medical Association.
The Balanced Budget Act of 1997 capped the number of available slots for residents coming out of medical school as part of the law's reduction in spending on Medicare, which largely funds residency programs. Meanwhile, Congressional gridlock is keeping the funding of doctor training programs off of any front burners on Capitol Hill.
Many of the younger physicians opt to become specialists instead of primary care doctors because the pay is better. Doctors, on average, graduate with $300,000 of debt and can't afford to work 80 hours a week and possibly earn $100,000 a year. As it stands now, the number of active physicians is getting older with 27.6 percent 60 years of age and older and only 17 percent of active doctors under the age of 40.
As the new health care law brings millions of Americans coverage next year and patients seek primary care doctors, there are some parts of the country that are in desperate need of doctors. In addition, the loss of private practice is another big problem. Because of regulations and other government disincentives to self-employment, doctors began working for hospitals or hospital networks in the early 2000s, leaving less than half in private practice at the start of 2013.
As the federal government cuts Medicare reimbursements, some physicians have refused to take patients who are 50 years of age and older because they don't want to be burdened with them when they reach retirement age. Medicaid is in the same predicament. The uninsured poor will soon have insurance, but they won't necessarily be able to find a doctor. In essence, the HCA will be of no benefit to some of the new Medicaid recipients.
All in all, it is easy to understand why those in Congress and the U.S. Senate exempted themselves from the Affordable Care Act.