By all accounts, the ACA has been an amazing success since it’s passage a few years ago.

Although the “media” portrays the ACA as a boon for doctors and hospitals, in reality, it has been a money loser for most doctors.

Although more people have “insurance”, their annual deductibles are sky-high, as much as $5,000 or $10,000 per person.   This means that the insurance companies do not pay the doctors or facilities until the patient has paid the deductible $$ amount for their health care for that calendar year.

So, when a patient with ACA health insurance comes to the doctor’s office, they are asked to pay the full amount for that office visit.  If this request is made prior to the office visit, the patient gets angry at the doctor’s office.   Many of these patients walk out without receiving health care.  If the request is made after the service is provided, then most of these patients do not pay, and the facility ends up “eating” the bill.

Another provision in the ACA allows policy holders to delay paying their premiums, which means that a person can secure a policy, obtain expensive medical services, and then decide to not pay their premium.  In effect, this means that they had no insurance at the time of service, since the insurance company will retro-cancel the policy for not paying the premium.

These factors have led to many physicians making a business decision in NOT accepting any patient with an ACA policy.  In effect, patients “think” they have insurance, but are unable to find any physician that will accept the insurance, which is the same as not having any insurance.

Over the next few years, these issues will become magnified, to the point where the country will be forced to re-consider a single payer model.   The risk and benefits of such a model will be discussed in a future blog post.