Republicans promise Obamacare will have you waiting weeks to see your doctor. One website says it can get you an appointment in 24 hours.
ZocDoc, a free online appointment-booking platform, allows patients to schedule last-minute doctor appointments by filling canceled or unbooked spots. The company launched in 2007, but it’s betting its services will be in new demand as the Affordable Care Act takes effect.
The health care law aims to extend insurance coverage to 25 million new patients over the next decade, and that would — by design — create new demand for primary-care doctors. But those are already in short supply, and critics warn that the influx of new customers will exacerbate long wait times.
If it works, ZocDoc and other sites like it would ease the strain on the primary-care system, as every last-minute appointment means one fewer patient in the waiting line. But even at their best, such sites would address only a small piece of the central problem: The nation has too many patients and not enough doctors.
Experts are divided over whether that problem exists because of Obamacare, or in spite of it.
Julia Paradise, an associate director at the nonpartisan Kaiser Family Foundation, says other factors are mostly to blame.
“Population growth accounts for close to two-thirds of the doctor shortage, with aging 19 percent and expansion 15 percent,” Paradise said, citing a study published in The Annals of Family Medicine. “The reality is that the strains in the system didn’t begin with the Affordable Care Act. People with very good health insurance can’t always get access to services when they need it.”
Paradise says geographic maldistribution — the concentration of physicians in particular, often more-affluent urban and suburban areas — is a systemic problem that has always been a barrier to care for residents of poor or remote neighborhoods.
Obamacare is attempting to address the doctor shortage by sweetening the pot for medical students who go into primary care, a discipline less lucrative than many specialties. In the hopes of closing that gap, the law boosts payments for primary-care doctors for two years.
It’s also incentivizing reforms to payment systems, encouraging doctors to provide better health outcomes the first time a patient walks in the door, and penalizing for readmissions at hospitals.
“Telemedicine can extend primary care in ways that wasn’t available to us before,” Paradise added.
But critics of the law are skeptical that those provisions can make up for the influx of new patients.
Grace-Marie Turner, president of the free-market-oriented Galen Institute, said the two years of higher pay for primary-care doctors isn’t enough to get someone to go to medical school. And, she said, the regulations are creating a paperwork burden for doctors who are worried about getting penalized.
“We need to let doctors do what they do, which is take care of patients,” Turner said. “But the third-party payment system has gotten so deeply ingrained in micromanaging doctors that they can’t do their jobs. I worry about the waiting lines.”
Other alternatives, such as allowing nurses to perform some tasks typically handled by doctors, have also come under fire.
“If you have a lot of people wind up practicing beyond their expertise, the patient is going to be harmed by that,” Turner said. “Politicians are not the right people to be making decisions about health care. The industry is.”
Consumers wait more than 20 days on average to see a doctor, according to a 2009 survey from Texas medical consulting firm Merritt Hawkins and Associates. That number is expected to rise given what happened in Boston after Massachusetts implemented its own health reform years before the Affordable Care Act was passed. The average wait time for a doctor’s appointment, the survey found, is 50 days. While wait times will vary across the country, Massachusetts could be the crystal ball of the future.
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"Even if House Republicans manage to get enough members of their party on board with the latest version of their health care bill, they will face another battle in the Senate: whether the bill complies with the chamber’s arcane ... Byrd rule, which stipulates all provisions in a reconciliation bill must affect federal spending and revenues in a way that is not merely incidental." Democrats should have the advantage in that fight, "unless the Senate pulls another 'nuclear option.'”
The House has passed a one-week spending bill that will avert a government shutdown which was set to begin at midnight. Lawmakers now have an extra week to come to a longer agreement which is expected to fund the government through the end of the fiscal year in September. The legislation now goes to the Senate, where it is expected to pass before President Trump signs it.
President Trump’s portrayal of an effort to funnel more Medicaid dollars to Puerto Rico as a "bailout" is complicating negotiations over a continuing resolution on the budget. "House Democrats are now requiring such assistance as a condition for supporting the continuing resolution," a position that the GOP leadership is amenable to. "But Mr. Trump’s apparent skepticism aligns him with conservative House Republicans inclined to view its request as a bailout, leaving the deal a narrow path to passage in Congress."
Democrats in the House are threatening to shut down the government if Republicans expedite a vote on a bill to repeal and replace Obamacare, said Democratic House Whip Steny Hoyer Thursday. Lawmakers have introduced a one-week spending bill to give themselves an extra week to reach a long-term funding deal, which seemed poised to pass easily. However, the White House is pressuring House Republicans to take a vote on their Obamacare replacement Friday to give Trump a legislative victory, though it is still not clear that they have the necessary votes to pass the health care bill. This could go down to the wire.