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The Affordable Care Act’s First Real-Life Medical Practice Casualty


One practice’s story is an example of how the ACA provides access to insurance, not care.

On July 9, I posted an op-ed entitled, “If ACA Survives, Many Small Medical Practices Will Fail.”

Not three months to the day, the following comment was posted in response:

“As the owner of a solo pediatric office that recently had to close my doors, I can attest to the effect of the ACA bill and small practices! I lived in rural TN with a 70 percent Medicaid population. I was struggling due to my high Medicaid population, but my philosophy of practice was to never limit the type of patients I saw. I provided care to everyone regardless of type of coverage. As a result, over the last two years I had to reduce my pay and cut corners everywhere I could as overhead expenditures kept going up and up and small practice reimbursements kept dropping. In January of this year ALL of my insurance carriers dropped their reimbursement rates, varying from 4 to 20 percent (20 percent being my Medicaid provider - my biggest payer!) … The overall impact to my practice was an 11 percent drop in reimbursement …

I was forced to close my practice and subsequently 2,000 patients in rural America - the ones the ACA was "supposed to help create access for all Americans" were left without adequate care as the other pediatricians in town could not absorb my entire patient load. I was the second physician in my town to close their doors in a year. Four others are reducing and cutting corners to try to remain open (all are solo practitioners). I have now moved 700 miles away and work for a large hospital-based corporation. I chose a hospital-based clinic because I felt it offered the most stability in the coming healthcare storm. I am still picking up the financial pieces of my practice failing. How many more will follow in my footsteps?”

Sheila @ Mon, 2012-10-08 14:27


Coincidentally, the letter was from a pediatrician (a specialty are not covered under the ACA’s provision paying Medicare rates for Medicaid patients in 2014 and 2015), making the case that practices simply could not survive and the consequence would be failed practices and reduced access to care.

This was no brilliant epiphany or prescient foresight. It was simple math. But, it was all hypothetical until the people are real.

Now they are - hundreds or thousands somewhere in rural Tennessee, and they are the most obvious, the most vulnerable, and the least able, among us. And, the unintended consequence that took the first casualty has surely infected and weakens the survivors by the day.

In its arrogance, Congress did not see fit to consult the people who would have to live with this legislation or the people who would have to make it work. In its hubris and naïveté, the ACA provides access to insurance, not care.

This is not about politics or ideology any more. Not right or left. Not entitlements or good or bad or evil intent or fair shares or no shares. Not special interests, insurers, or doctors, hospitals or bloviating pundits or politicians. It is about us, all of us. It will persist until people who know what they are doing are allowed to set things right.

I am hopeful that politics will be set aside and that the wait will be short.

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