Rep. Darrell Issa's House Oversight and Government Reform Committee held another hearing on the impact of Obamacare, this time scrutinizing reports that the health care law is driving up insurance costs and leading to fewer doctor choices for consumers.
The Washington Examiner listened to the 3 hours of detailed and often contentious questioning so you wouldn't have to. Here are 10 takeaways:
1. Dr. Jeffrey English, a neurologist at the Multiple Sclerosis Center of Atlanta, testified that his MS patients will suffer because of the law's unintended consequences. He said the Affordable Care Act punishes doctors like himself who serve the most vulnerable patients because he recommends too many MRIs, brain-Image scans and costly medicines compared to his peers.
The Centers for Medicare and Medicaid Services, he said, had placed him into the same pool as other general neurologists and even orthopedic surgeons without taking into account that he specializes in extreme MS cases. Because of this, he said, CMS has warned him that he will have a lower rating on its website, which will include data that he “overused MRIs.” For this same reason, United Healthcare recently downgraded him to “non-preferred” status.
“In reward for my passions to prevent real people from becoming disabled, CMS and insurance companies like United Healthcare are going to post negative grades in my name,” he said. “They will financially penalize me or the institution I work for, as I am trying to practice quality care to some of our most vulnerable patients.”
2. English also testified that in Georgia, the state Obamacare insurance exchanges are limiting the pool of doctors and specialists that patients can see and are only providing coverage for four out of the 10 therapies he usually recommends for MS patients.
“Patients like my previously-paralyzed schoolteacher are afraid that the medication that has kept them functioning may be taken away, leading to disability,” he said.
3. Dr. Patricia McLaughlin, an ophthalmologist in solo practice in New York City, testified that insurers are responding to Obamacare by announcing the creation of new limited networks and some plans that will offer only in-network benefits, excluding all out-of-network doctors.
She said these more restrictive networks are impacting plans serving small business groups, including her own, as well as plans offered to individuals on various state exchanges and healthcare.gov. She recalled receiving a cancellation of her health care plan a few months ago and said the new plan had a $500 higher deductible and slightly higher premiums. But the biggest change she discovered so far is the new plan's far more limited network of participating physicians.
On top of those disappointments, she received a notice in November that she had been bumped from the plan as a participating physician with no given reason. She said she and her two employees soon found that they would lose their primary-care physician unless they chose to see him through a completely non-covered private arrangement.
4. McLaughlin also testified that she believes her patients, who are located in Manhattan — where housing costs are much higher than other areas of the country — are going to have a tough time paying the state health exchange plans' high deductibles.
“How is a person earning $50,000 ... paying $2,000 rent for a hole-in-the-wall studio in New York City, going to be able to pay a $3,000 deductible and has a 50-percent co-insurance rate afterward for a plan that was announced as affordable?” she asked. “We cannot have a whole nation of patients in collection and we can't have a whole nation of physicians and hospitals fighting to get paid.”
5. Dr. Eric Novack, an orthopedic surgeon in Arizona, testified that the Affordable Care Act's expansion of Medicaid would exacerbate a problem with low government reimbursements to hospitals, leading to more and more hospitals opting out of the program and patients losing their doctors and access to nearby care.
He said the physicians group he belongs to, OrthoArizona, has chosen not to belong to any Obamacare insurance exchanges because the Medicaid reimbursement rates are so low and there is a 90-day grace period for the policies.
“This means we can provide two months of care thinking the patient has coverage, and then we are 'on the hook' for the payment, and the insurers have no responsibility."
He said at least one Phoenix-area hospital system has opted not to participate in Obamacare exchanges in large part because the rates being offered are at or near Medicaid rates.
Think Tank findings
6. Avik Roy, a senior fellow at the conservative Manhattan Institute for Policy Research, described the findings of his study of individual-market premiums in 2014 relative to 2013.
His analysis found that the average state will see a 41-percent increase in underlying premiums prior to the impact of Obamacare subsidies. Among the states seeing large increases are Nevada (179%), New Mexico (142%), North Carolina (136%), Vermont (117%) and Georgia (92%).
The analysis also found that eight states will see average premiums decrease under the law, including Massachusetts (-20%), Ohio (-21%) and New York (-40%).
7. Edmund Haislmaier, a health care expert at the conservative Heritage Foundation, said the way Obamacare provides cost-sharing subsidies for coverage is causing the narrower doctor options.
“Insurers recognize that the only way they will be able to control plan costs is by limiting coverage to a smaller number of providers willing to accept low reimbursement in return for a high volume of patients,” he said.
Given that dynamic, Haislmaier said it isn't surprising that when analyzing insurer exchange participation patterns, he found that among the 254 insurers participating in the exchanges, 50 of them (20 percent) had Medicaid managed care as their current principle business in the state in which they are offering exchange plans.
8. Judith Feder, a Georgetown University professor and a fellow at the liberal-leaning Urban Institute, was the only witness Democrats had requested. She testified that she has spent her entire career examining the challenges facing the nation's health care system. She said over that time she has seen the number of Americans without health insurance rise to 50 million “even as Americans who have health insurance spend more and more to hold onto it.”
Feder did not address evidence of rising deductibles and premiums under the Obamacare rollout but credited the law with a “remarkable slowdown in the growth of health care costs.”
“Health care spending per person from 2010 to 2013 is growing at the lowest annual rate on record for any three year period,” she said.
9. Rep. Gerry Connolly, D-Va., complained that Republicans on the committee had cherry-picked doctors who were most critical of Obamacare and had refused to allow more supportive witnesses to testify.
“We could have chosen our [own group of doctors], and we could ask you to wear the white coat and could get a very different story,” he said. “But the idea that your positions are meant to be universal ... it isn't an honest intellectual pursuit to deliberately cherry pick doctors” who are critical.
Issa then displayed a powerpoint slide of Connolly's official website from 2010 in which he promised that the Affordable Care Act would bring down premiums for families and small businesses. Issa asked that it be put into the official record of the hearing, prompting Connolly to complain until Issa cut off his microphone.
10. At another point during the hearing, Issa cut off a line of questioning from Rep. John Tierney, D-Mass., who he said had used all of his allotted time. Immediately afterward, Issa asked if the witness would like to expand on anything Tierney had asked her because time constraints had led him to cut her off several times.
Tierney objected to Issa's action, saying “Now you are just a model of —” before Issa cut off his microphone.