Dr. Eduardo Martinez, vice president of the Dade County Medical Association, told the Herald that doctors don’t want the burden of collecting from exchange-plan enrollees who face high deductibles. “How do I plan for a patient who needs to have surgery that’s a large amount of money?” he asked. “Who do I send him to? Which of my colleagues do I refer him to, knowing that my colleague is going to take a financial hit?”
Jeff Scott, general counsel for the Florida Medical Association, said doctors “have no idea that they’ve just been signed up to participate in a plan with a patient population who are … probably not financially well off, and they just signed up for a plan that has a 40% co-payment and potentially high deductible.”
What the Herald didn’t mention in its otherwise solid article—and what might change these doctors’ views—is that many or even most of those Obamacare patients qualify for ACA cost-sharing subsidies that cover up to 94% of their total out-of-pocket costs. People are eligible as long as they have an income below 250% of the federal poverty level, and have signed up for a silver-tier plan.
The cost-sharing subsidy has received far less attention than the federal premium tax credit, but it’s just as important in making healthcare affordable for lower-income Americans. It ranges from covering an average of 94% of costs for enrollees with incomes between 100% and 150% of the federal poverty level, to 87% of costs for those between 151% and 200% of the poverty level, to 73% of costs for those between 201% and 250% of the poverty level. Members of silver-tier plans with higher incomes only get coverage for an average of 70% of their medical costs.
There are no published data on what percentage of Obamacare enrollees qualify for the cost-sharing subsidies. But South Florida has a large population of lower-income workers in service industries with incomes under 250% of the federal poverty line. And since most enrollees in Florida, as in other states, have signed up for silver-tier plans, it’s almost certain that a significant number of Obamacare enrollees there qualify for the cost-sharing reductions.
When I asked Miami Herald reporter Daniel Chang why he didn’t mention the subsidies in his article, he said he thought of it but decided not to, because he wanted to focus on the fact that physicians are refusing to see exchange-plan patients, and his sources didn’t mention the issue of cost-sharing subsidies. “I don’t think the cost-sharing subsidy changes the whole picture when you’re dealing with physicians who appear to have a pre-conceived notion about these patients and their plans,” he wrote in an email.
Perhaps those pre-conceived notions would break down if more doctors and patients were made aware that the healthcare reform law provides financial assistance to lighten out-of-pocket cost burdens.
Follow Harris Meyer on Twitter: @MHHmeyer