Obamacare & California: State media ignore coming headaches

Obama convention speech, Sept. 6, 2012Jan. 27, 2013

By Chris Reed

Gov. Jerry Brown’s eagerness for California to be the first state to implement the federal Affordable Care Act is being reported matter-of-factly by state newspapers. Completely absent is any big-picture explanation of what this will mean for health providers, companies and individuals in the Golden State. We’re less than a year away from the state implementing policies that give employers a financial incentive to stop providing health coverage and that give individuals, especially the young, an incentive to not buy health insurance. I wrote about these enormous looming headaches last week for the U-T San Diego editorial page:

• Beginning next Jan. 1, most companies with at least 50 full-time employees have to offer health insurance. But if they don’t, the fine is a pittance -– $2,000 per employee per year –- compared with the cost of providing health insurance. This creates a gigantic incentive for businesses to drop health coverage and push their employees toward getting insurance though government-run exchanges set up by Obamacare. If a struggling company could swiftly become a prosperous one by offloading 70 percent or more of the cost of providing health coverage, many thousands are going to do it. Some might face shareholder suits if they don’t.

• Also beginning next January, individuals without employer-provided health insurance will face fines under an income-based formula that mandates a penalty of less than $1,000 for those making under $40,000 a year. That $40,000 is significantly higher than the median household income for adults younger than 35, a subset that’s much healthier than older adults. All adults will have an incentive to only buy health insurance when they get sick; under Obamacare, they can no longer be rejected for pre-existing conditions. But these young, healthy adults will have a gigantic incentive.

Aren’t these angles, yunno, news? Not to most of the media in the Golden State, which focus on the logistical headaches of setting up the state health exchange in which people shop online for insurance. Why not focus on the larger problems with the Affordable Care Act? No idea, but my working theory is that not just sheep but incompetent sheep follow the herd.

Want an appointment? Tough luck

How bad is this refusal to say a discouraging word about Obamacare? Consider this angle, which should be a front-page story and which invariably surprises people when I mention it to them:

“California already has both shortages of family doctors in most regions and the nation’s oldest cohort of family doctors, with nearly 30 percent older than 60. If you add 2 million people to those being treated by these family physicians –- the minimum California increase expected in 2014 because of Obamacare -– what happens? It becomes far harder to get an appointment, and the headache gets progressively worse as more aging family doctors retire.”

This has gotten some coverage from the Golden State’s media. But given the importance of health care in everyone’s lives, one would think it would get far, far more coverage. We already have a shortage of family doctors in most parts of the state — and it’s a shortage that’s about to get far worse because of physician retirements and Obamacare.

Huge news? Of course.

But not to the sheep in the herd.


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  1. Rob McMillin
    Rob McMillin 27 January, 2013, 11:51

    I recently retired from an employer that carried health care. I am far too young for Medicare, and so I have lately started casting about for my best option in this space, which seems to be one of three things:

    1) I can join a physician group as a patient, and pay as needed for office visits, labs, and meds, while getting a high-deductible insurance policy for most everything else. I spoke to a neighbor, who is a GP, about this prospect, and she discouraged me from signing up to her eight-physician practice thanks to the large numbers of new patients they are already enrolling thanks to Obamacare. Also, it is unclear but that Obamacare will functionally make this illegal anyway.

    2) I can sign up for concierge medicine, and as with (1), buy catastrophic insurance to pay for high-expense, low-likelihood events. There appears to be an AMA-derived carve-out exempting this from the insurance purchase mandate.

    3) I can join a traditional PPO/HMO as an individual, i.e. Blue Cross/Blue Shield, or some other insurer.

    All three are pricey, from what I can tell so far, but the hard part is even trying to find a high-deductible plan that isn’t obscenely overpriced — or, at all. Obamacare is already making medicine notably worse, while actually driving real costs up.

    Reply this comment
  2. Hondo
    Hondo 27 January, 2013, 17:40

    I sure hope this obama care works. We have no other choice now.

    Reply this comment
  3. Jim
    Jim 27 January, 2013, 18:19

    They plan on making up for the shortage of family doctors with a bunch of Physician Assistants (PA). Don’t you feel better already?

    Reply this comment
  4. us citizen
    us citizen 27 January, 2013, 18:36

    If its government ran, it isnt going to work.

    Reply this comment
  5. Kurt Hahn
    Kurt Hahn 27 January, 2013, 18:55

    RATIONING OF HEALTHCARE PRIMARILY TO SENIORS COMES NEXT A;; Medicare patients will be grouped into Accountable Care Organizations based upom the physician they used in the proceeding three years. The ACO will function much like the big bad HMO’s of two decades ago. If one needs to access a specialist outside the geographical area ofthe ACO at a University Teaching Hospital for example that may have partisipated in trials of a new treatment that you need you will be hard pressed to get a referal because the ACO gets paid on a shared saving basis. So much for being able to go to a Specialist without a referal if you are on Medicare. Rationing here we come.

    Reply this comment
  6. Hondo
    Hondo 27 January, 2013, 21:07

    Like they say, if you think health care is expensive now, wait till its free.

    Reply this comment
  7. Rex the Wonder Dog!
    Rex the Wonder Dog! 28 January, 2013, 20:31

    I am the black sheep here, I say give Obamacare a chance, if it sucks eggs, overturn it.

    Reply this comment
  8. Ed
    Ed 30 January, 2013, 10:54

    The whole debate about Obamacare good or bad is irrelevant. If it does not work well it can be amended. Why are people freaking out rather than realizing that we are catching up with the rest of the world, since most countries already have a govt ran healthcare for their people. Is it all hype ran by the healthcare industry that realizes that the US has the highest cost healthcare in the world and mediocre benefits which maximizes ins profits? Thy obviously saw it coming since the ins companies started jacking the rates sky high 10 years ago at increased rates never seen anywhere else in the world.

    Reply this comment

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