An estimated seven out of every 10 physicians in deep-blue California are rebelling against the state's Obamacare health insurance exchange and won't participate, the head of the state's largest medical association said.
“It doesn't surprise me that there's a high rate of nonparticipation,” said Dr. Richard Thorp, president of the California Medical Association.
|Independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting the exchange.|
Thorp has been a primary care doctor for 38 years in a small town 90 miles north of Sacramento. The CMA represents 38,000 of the roughly 104,000 doctors in California.
“We need some recognition that we’re doing a service to the community. But we can’t do it for free. And we can’t do it at a loss. No other business would do that,” he said.
California offers one of the lowest government reimbursement rates in the country -- 30 percent lower than federal Medicare payments. And reimbursement rates for some procedures are even lower.
In other states, Medicare pays doctors $76 for return-office visits. But in California, Medi-Cal's reimbursement is $24, according to Dr. Theodore M. Mazer, a San Diego ear, nose and throat doctor.
In other states, doctors receive between $500 to $700 to perform a tonsillectomy. In California, they get $160, Mazer added.
Only in September did insurance companies disclose that their rates would be pegged to California’s Medicaid plan, called Medi-Cal. That's driven many doctors to just say no.
They're also pointing out that Covered California's website lists many doctors as participants when they aren't.
“Some physicians have been put in the network and they were included basically without their permission,” Lisa Folberg said. She is a CMA’s vice president of medical and regulatory Policy.
“They may be listed as actually participating, but not of their own volition,” said Donald Waters, executive director of the Alameda-Contra Costa Medical Association.
Waters' group represents 3,100 doctors in the East Bay area that includes Oakland, with an estimated 200,000 uninsured individuals.
“This is a dirty little secret that is not really talked about as they promote Covered California,” Waters said. He called the exchange's doctors list a “shell game” because “the vast majority” of his doctors are not participating.
Independent insurance brokers who work with both insurance companies and doctor networks estimate that about 70 percent of California's 104,000 licensed doctors are boycotting the exchange.
Mazer, a past president of the San Diego County Medical Society, agreed, saying, “I cannot find anybody in my specialty in the area that has signed a contract directly with any of these plans.
"The real question," Mazer added, "is how many doctors have signed up for how many programs, and whether there’s more than 50 percent participation.”
Dr. Sherry Franklin, a pediatric endocrinologist at Rady’s Children’s Hospital, San Diego, and at the University of California San Diego Hospital, isn't joining the exchange.
Franklin said last summer she "got a letter in the mail letting me know if I wanted to participate with Blue Cross through the exchange, which is different from my regular Blue Cross practice, because they are paying less. They did not tell me how much less. You had to agree or disagree. So, of course, I said no."
For its part, Covered California expects as many as 85 percent of the state’s doctors will join the new exchange.
“The Covered California board says we have plenty of doctors, and they allege they have 85 percent of doctors participating," notes Mazer. "But they’ve shown no numbers."
The exchange issued a May release making that claim before doctors could respond to a memorandum of understanding from insurers. Most didn't because the MOU lacked reimbursement rates.
“When they sent out MOU information and said, ‘Would you be willing to participate?’ earlier this year, most of us said, ‘How about sending us the rates?’ " Mazer recalled.
Mazer said that not only are many doctors not participating, but many are also thinking of retiring.
“I just turned 55, and a lot of us are kind of going, ‘Maybe there’s something else we can do in the last 10 years,’ because this is just getting too onerous to keep on going.”
If a large number of doctors either balk at participating in the exchange or retire, the state’s medical system could be overwhelmed.
No one is more aware of this than Alex Briscoe, health director for Alameda County Health Care Services Agency, which includes Oakland.
“Enrollment doesn’t mean access, because there aren’t enough doctors to take the low rates of Medicaid,” he said. “There aren’t enough primary care physicians, period.”
Briscoe hopes his eight community health centers can handle the 200,000 uninsured individuals he said reside in his county, but he warned that “there is a doctor shortage. It is going to get worse as more people enter the market.”
Briscoe professed not to be surprised by the refusal of doctors to participate in Covered California. “It rings true. I’ve been kind of wondering in my head, ‘How are they offering such low premiums?’ ”
A spokesman for Anthem Blue Cross declined to comment on doctor participation in its commercial and exchange networks, claiming it would not be an “apples to apples” comparison.
Blue Shield of California did not return phone calls and emails.
Covered California did not respond to the Examiner's questions about doctor participation and the accuracy of the exchange's participating doctors list.