Healthcare in a Minute – November 2017

By George W. Chapman

ACA in Flux Again

The Graham-Cassidy bill was last attempt by the Senate to repeal and replace the ACA and it never made it to the floor for a vote. Consequently, the ACA will remain law of the land for at least another year. As of Sept. 30, the Senate will need 60 votes (not just 50) to pass any bill replacing the ACA. Since the odds of that happening are close to nil, the Senate may actually have to work on a bipartisan solution. In the meantime, President Trump signed an executive order to terminate the premium subsidies for the exchanges. Without the subsidies, millions of people won’t be able to afford the full premiums and the ACA would crumble. Nineteen state attorneys general have filed a suit against the federal government for discontinuing the premium subsidies. Is President Trump simply sabotaging the ACA? Or is he really forcing the Senate, Democrats and Republicans, to get to the table and come up with a solution?

Selling Across State Lines

President Trump’s Executive Order also allows insurers to sell across state lines. There is a provision in the ACA that allows sales across state lines, but details were never formulated. However, this is easier allowed than done. Insurers are reluctant to cross state lines because of the expenses associated with complying with varying state rules and regulations and then having to establish broad enough provider networks to care for potential members. In any event, the Department of Health and Human Services ultimately approves crossing state lines.

Demand for Physicians

According to the national physician placement firm Merritt-Hawkins, newly trained physicians are being besieged by a record number of solicitations from hospitals, medical practices and recruiting firms. Seventy percent said they have received more than 50 contacts — some have received as many as 100 contacts. The Association of Medical Colleges predicts a shortage of between 41,000 and 105,000 physicians in just 12 years. (Their dire prediction does not account for nurse practitioners and physician assistants). Right now, primary care and psychiatry residents are, on average, receiving the most contacts. Rural areas face the toughest recruiting battle. Only 4 percent of residents prefer to practice in communities under 25,000 people. New physicians overwhelming prefer to be employed versus striking out on their own. Forty-one percent of the residents surveyed prefer hospital employment and 34 percent prefer medical group employment. It seems that independent solo practitioners are nearing extinction.

Uninsured, New Low

According to the US census bureau, the nation’s uninsured rate dropped to 8.8 percent (about 28 million people) primarily due to the expansion of Medicaid. In 2009, the uninsured rate was 17 percent. The uninsured rate has dropped in all 50 states. Massachusetts, again, has the lowest rate of uninsured at 2.5 percent due to its universal mandate requiring all citizens to have coverage.

Good Health

It depends on a lot of factors, some of which are out of your control. Fifty percent of good health is determined by living a “good life,” which includes a decent income, no disabilities, a good education and a satisfying job. Race and gender impact a “good life” as well. Twenty-five percent of good health is determined by the medical and dental care you receive. Fifteen percent of good health is predetermined by your biology and the final 10 percent by your environment. Ninety-three percent of healthcare spending in the US is spent on hospitals, physicians and drugs or, virtually, on “damage control.” Only 7 percent of healthcare spending is for public health or social initiatives which typically address education, income inequality, racial discrimination, drug abuse, disabilities, the environment and research. Health experts believe that more investment in public health will have a tremendous return on investment by improving our overall health and significantly reducing “damage control.”

95 Percent Satisfaction, But…

According to an independent survey of more than 1,700 adults, commissioned by the Physicians Foundation, 95 percent of respondents said they were satisfied or very satisfied with their primary care provider. But only 11 percent of patients, and 14 percent of physicians, felt there was enough time spent during a visit. Ninety percent of those surveyed felt the most important component of quality care is a strong physician-patient relationship. The cost of care is a major concern with 57 percent saying they are only one sickness away from serious financial trouble. (Unpaid medical bills are now the No. 1 reason for personal bankruptcy). Eighty-eight percent of respondents see drug prices as the main contributor to rising costs, followed by the absence of free markets and fraud. Electronic records may be the main culprit for not enough time spent during a visit. According to research from the AMA, primary care physicians devote four hours a day during office hours, and then another two hours after office hours, on just keeping electronic records up to date.

New Medicare Card

Social security numbers will gradually be replaced by unique, randomly assigned identification numbers beginning in April 2018. All Medicare members should have the new cards with their new ID number by April 2019.  Removing the SS number will help deter identity theft and fraud, which have cost the taxpayer about $60 billion a year, which is about 10 percent of all Medicare spending.

Coverage Outside US

Call your plan before traveling out of the country. Depending on your commercial insurance, you could have no coverage or partial coverage. Straight Medicare does not cover you abroad, but Medicare Advantage Plans offer some coverage. Temporary coverage can be purchased. The price depends on where you are going and for how long. Check out coverage abroad at

George W. Chapman is a healthcare business consultant who works exclusively with physicians, hospitals and healthcare organizations. He operates GW Chapman Consulting based in Syracuse. Email him at