Confessions of a rebound doctor: The impact of narrow networks

“We lost our regular doctor with Obamacare, so now we have to see you.”

I routinely ask my new patients how they heard about our pediatric office, and this is the answer I dread most. My pediatric practice is a very nice and modern private office, and in my opinion, full of excellent physicians. I entrust my own children’s care to my partners. But none of that matters when you’re the rebound doctor, the only option for patients after Obamacare jilts the lifelong relationship with the doctor they truly loved.

After an answer like this, an awkward silence follows as I try to navigate some sort of apology-welcome-to-the-new-office type response. It’s a horrible feeling to have a new patient against their wishes.  These awkward conversations burn in my throat as I hear the president’s intentionally false campaign promise ring in my ears, “If you like your doctor, you can keep your doctor.” Our president knew it was untrue was he said it, those of us in the medical field knew it was untrue when we heard it. Now I have to face Americans who really liked their doctor, wanted to keep their doctor, but now banned from seeing their doctor due to Obamacare and forced to bring me up to speed on years of medical and personal history on their children.

It’s particularly frustrating because these are hard-working families pushed into the exchanges.  Some have lost their employer-based health insurance as they were cut to part-time hours due to Obamacare. Others are self-employed individuals losing their old affordable high-deductible plans made illegal by Obamacare.  The most ironic are the employees from the largest health system in our city, which is aggressively cutting employees to part-time so they can dump their health insurance.

The cheapest exchange insurances are the narrow network products, costs are kept down by severely limiting choice. We currently participate in a narrow network insurance product, the only pediatric option in a city full of amazing pediatricians and family doctors. Choosing the narrow network exchange insurance means these families are almost guaranteed to lose their trusted family doctors in order to obtain some form of health insurance. For the employees at that health system cutting hours … it means their employees cannot see the doctors within their own hospital!

As a professional, I do my very best to earn the trust of every family in my office. But the overwhelming uncertainty of Obamacare weighs on me. I know many of these families can only afford the exchange insurance because of taxpayer-funded subsidies and those subsidies are likely illegal. Michigan is a state that wisely opted to have the federal government run the exchange.  I say wisely, because the logistical nightmare of inventing the Exchange was clear from the beginning. The colossal and expensive failures of state-run exchanges in Oregon, MassachusettsMaryland, and Rhode Island are real life case studies pointing to the wisdom of our state legislators here.

However, Obamacare as written, does not allow taxpayer subsidies to be used on federal exchanges.  The Obama administration is currently ignoring their law and giving subsidies to those purchasing insurance on federal exchanges anyway. The recent Halbig ruling brought the issue to light, but hasn’t clarified it. The subsidies still hang in political limbo, which means my new patients are in limbo as well.

The solution seems so clear in my little corner of the world. I want my patients to have control over their own health care dollars regardless of employment status or political party in power. I want to work directly with my patients to help them choose how to best use those dollars in a price transparent health care environment. I want them to choose me. I want competition to push me to provide the best care at a good value, knowing that my patients always have a choice to see another doctor if I’m not doing a good job. In short, I’d love folks to own a high-deductible HSA for life, in a health care system that is transparent and competes for those dollars.

But that would give power directly to the patient and all the health care choices between the patient and the doctor. Turns out, there are more powerful players that want control over what happens in my office. I think about this sometimes, as I sit down with a new patient being thrown about in the system. There are so many other people in the room with us telling us how the be patient and doctor, from the IT companies and the mandated electronic records, HITECH, the insurance companies and the proper codes, meaningful use, Choose Wisely, insurance company incentive programs, preferred drug lists and prior authorizations, in-network providers and out-of-network providers, on and on. It’s overwhelming.

And so I take a deep breath and focus on what I can control, welcome the new family to the office, help the toddler pick out her Doc McStuffins sticker and hope for a day when a bureaucrat somewhere isn’t the one to determine how long this relationship will last.

Meg Edison is a pediatrician and can be reached on Twitter @megedison.  This article originally appeared on Rebel.MD.

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