California’s budding doctor rebellion against Obamacare appears to be genuinely spontaneous, lacking leadership from a single individual or organization.
As the Washington Examiner has reported in recent days, an estimated 70 percent of California's physicians -- ranging from general practitioners to specialists -- are "just saying no" to Obamacare's Covered California health insurance exchange.
|This movement is going to be even more powerful because the man on the street will realize he can't keep his doctor and his hospital.|
Although it appears leaderless, some observers believe that very spontaneity may make the doctor rebellion a formidable force in California’s health-care future.
“Doctors are realizing what is happening and spontaneously they are acting like this. There’s a movement growing,” said Sally Pipes, president of the San Francisco-based Pacific Research Institute and an Obamacare critic.
Pipes said an insurrection without leadership sometimes is the most lethal kind to force change.
“It’s not like having someone at the head to say ‘You have to do this, you have to do that.’ This is much much more powerful, in that doctors individually are coming to this realization, and are not by being told,” Pipes said.
For the moment, some physician groups are shying away from holding the reins of the movement.
Officials with the California Medical Association, which represents 38,000 of the 104,000 licensed doctors in the state, told the Examiner their organization is not leading physicians opting out of Obamacare.
“We’re in no way endorsing participation. We are in no way discouraging participation,” said Lisa Folberg, a CMA vice president.
CMA finds itself in a delicate position as many of its members, including some of its most prominent officers, are publicly declining to participate in Covered California.
Yet, as an organization, CMA needs to maintain good relations with the exchange. Covered California awarded a $1.5 million contract to CMA’s foundation to help inform doctors about consumer eligibility and enrollment, according to Folberg.
Molly Weedon, a CMA spokesman, also downplayed the grassroots phenomena.
“Talking with individual physicians, many of them have come to the same conclusion that many of them are not able to participate in an exchange," Weedon said.
"But those are all individual decisions based on what their practices are. I don’t see that as an organized boycott or rebellion,” she said.
But however many doctors are actually opting out of Covered California, it has the look and feel of an informal movement.
Patrick Burns, a San Francisco Bay-area independent insurance agent said, "You are getting down to the 35-percent level in terms of total participating doctors. Yes, 60-70 percent of the doctors are not participating” in Covered California.
Dr. Richard Thorp, CMA's current president, said doctors are being forced to make rational business decisions.
California has among the lowest Medicaid reimbursement rates in the nation. Covered California insurers use low rates to reimburse participating doctors.
“Most of the folks who are looking at that are making a business decision about what they can do to remain viable in practice,” Thorp said.
But Pipes said what makes the grassroots reaction powerful is that the motivation of participants is personal and moral.
“They’re taking personal responsibility. They’re individuals. And they are acting on what they think is right,” Pipes said.
Colleen Callahan, a independent insurance broker in Pleasant Hill, in the East Bay area of San Francisco, said the large withdrawal of doctors will mean far fewer physicians will be available to care for patients in the exchange.
Callahan said she saw the impact in comparing OB-GYN doctor availability inside the commercial Anthem Blue Cross network and inside Anthem’s exchange network.
“I checked OB-GYN’s," she said. “What I thought was interesting [was], in the in-network group, they [Anthem] had 83 doctors. But on the exchange in individual plans, it only had 10.”
Pipes makes a similar point: “This movement is going to be even more powerful because the man on the street will realize he can’t keep his doctor and his hospital. It’s more ammunition that Obamacare is not working.”