Fox: Patients who can’t use their exchange plans

Some ObamaCare patients with high deductibles turning to community care centers

By Jim Angle
Fox News, November 4, 2014

When ObamaCare patients learn their deductible is so high they’re unlikely to get any reimbursement, they often wind up in places like the Denton, Texas Community Care Center.

"There are quite a few, and I saw another one today, where their deductibles are so elevated that they can't afford them," said Dr. Flippo Masciarelli, chief physician at the center, which was designed to treat indigent patients.

Robert Laszewski of Health Policy and Strategy Associates noted, "You're going to the doctor, you're paying (a) premium, and because of this really high deductible, you're not getting any benefits."

The administration pushed insurance companies to keep premiums low, but that also created high deductibles, about $5,000 per person for the least expensive plan, as well as narrow networks of providers.

But most people buy based only on premiums.

"They don't even look at what their deductible is going to be," said Dan Mendelson, CEO of Avalere Health. "They don't look at the cost of the medications that they're on. And they don't look at that they have."

Masciarelli said,"one of the ladies we saw said she called eight primary care offices before she found us..." The rest would not treat people on her plan. 

If the doctor these patients find orders additional tests or treatment, even those with ObamaCare are sometimes forced to go without.

Health economist John Goodman said, "They go to community health centers because it's free or almost free and or very low charges. And that's why they're doing it. So they were coaxed to go into the ObamaCare system, they're paying premiums over there. And now they're asking what did I get for my premium? I'm having to go outside the system to get health care."

Masciarelli agreed. "We do get asked that question at times, yes, wondering you know, I have this product. I can't even use it. "



By Don McCanne, MD

Although this is a typical Fox News anecdotal report not based on any scientific study and designed to discredit "ObamaCare," nevertheless it does make a very valid point. People obtaining their coverage through the insurance exchanges are finding that, with the narrow networks and high deductibles, they “can’t even use” their plans.

Fortunately these patients do have the backup that the 30 million people who will remain uninsured have - community health centers. But they will still have impaired access to specialized services because of unaffordable cost sharing, and because of a lack of specialists who are willing to provide services through the community health centers.

Although these plans do provide coverage for catastrophic events, it is primarily the providers rather than the patients who benefit. Because of EMTALA regulations, the patients would receive the care anyway, but the providers will be paid rather than having to write the care off as a loss. It is just one more example of how the system was designed to take care of the medical-industrial complex rather than placing the patient at the pinnacle.

Single payer would get rid of the narrow networks and unaffordable cost sharing, so no patient would be rejected based on the limitations imposed by the private insurers. But then that would deprive Fox News of these anecdotal reports that they use to bash President Obama. So what is our priority here?