The historic health care reform bill signed into law by President Barack Obama drew mixed initial reactions from physicians and hospital administrators in Westchester County.
The 800-physician Westchester County Medical Society strongly opposed the bill, with 95 percent of the members who attended a protest meeting a few days before the House vote speaking against it, according to medical society officials. The medical society in a statement said while the patient Protection and Affordable Care Act did address needed insurance reform, the rest of it amounted to “excessive governmental intrusion into the health care system as well as the physician-patient relationship” and failed to deal with low Medicare payments to physicians and medical malpractice liability reform.
One hospital CEO in the county said while the measure was good for the country with its roughly 35 million uninsured citizens and for physicians, it was a “significant negative” for his and other hospitals that care for low-income patients and stand to lose more Medicare funding as the bill”™s provisions are phased in.
“I would believe that the intention of the people that composed the legislation was good,” said Dr. John J. Stangel, a reproductive endocrinologist in Rye and president of the Westchester County Medical Society. “I think it”™s loaded with unintended consequences.”
In Westchester, said Stangel and other medical society members, the law”™s intent to increase physician-patient access could have the reverse effect.
At current reimbursement rates, “Most physicians are running at a barely tolerable loss with each Medicare patient that they”™re seeing,” said Stangel. The reform bill will increase the number of patients eligible for Medicaid coverage by raising income eligibility levels and could reduce doctor”™ reimbursements from the Medicare program.
“If we increase the number of patients going in, what you”™re doing is multiplying the loss and that makes it financially intolerable,” Stangel said. Some doctors could go out of business, a loss that would have a large ripple effect in the area”™s economy, he said.
“There were already doctors considering dropping Medicare patients before this,” said Stangel. “This will only make that worse.” That will result in patients being deprived of access to coverage.
Brian Foy, executive director of the county medical society, said despite the increase in persons covered by insurance, “You”™re going to have a harder time seeing the doctor. Medicare and Medicaid are too restrictive. They don”™t give a doctor any flexibility, so the doctors are going to be selective in their patient volume.”
Dr. Andrew Y. Kleinman, a plastic surgeon in Rye Brook and a past president of the county medical society, said the new legislation could impose an additional $1 billion liability for Medicaid payments on New York state, which he said has been one of the most progressive states for health care coverage of low-income residents and regulation of insurance companies. “For New York, this is a particularly bad deal,” he said. “The bottom line, New York state is getting screwed with Medicaid legislation.”
Kleinman said the legislation basically would eliminate New York”™s Child Health Plus subsidized insurance plan and replace it with Medicaid coverage for children. Most physicians like the state”™s plan but don”™t like Medicaid because its rates are unreasonable, he said. For children, “If they have Medicaid, and no one takes Medicaid, they have no access,” he said.
Kleinman said the bill does not address the issue of Medicaid reimbursement rates for other than primary-care physicians. In New York, the rates for many years have been the lowest in the country, he said. “If reimbursement for surgery is so little that you could do 50 surgeries in a day and still not cover your overhead, then it”™s not a viable bill,” he said.
“We really do need health care reform,” said Kleinman. “The idea is great; the implementation has been poor. Unfortunately it became political, when it should have been done in a businesslike fashion.”
“People who are right in the middle of the road politically don”™t get it ”“ why this bill was passed,” he said.
In Yorktown Heights, another Westchester County Medical Society member, Dr. Richard Klein, an internist and infectious disease specialist, called the reform measure “a compromise bill.” Despite its limitations, particularly with respect to high-profiting insurance companies and the lack of a public option for health plan buyers, “It is a step forward,” he said.
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Klein said he favors a single-payer, government-sponsored system. “Fix Medicare and give it to everybody in the country,” he said. “I would prefer getting insurance companies out of the business of health care. They make $400 billion a year just by doing what they”™re doing now.” With the new law”™s provisions to insure 90 percent of Americans, extend coverage for young adults under parents”™ plans and prevent insurers from denying coverage to persons with pre-existing conditions, “It will insure that $400 billion more will be going to insurance companies,” he said.
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“This is the only country where you can go bankrupt even if you have insurance,” Klein said. He said his father-in-law, who died of cancer, had a $1.2 million health care bill. The father-in-law”™s family will be forced into bankruptcy because they cannot afford their $300,000 portion of the bill.
New policyholders will have similar coverage and similar risks of bankruptcy with the compromise health care reform measure, he said. “Unfortunately, this bill has some side effects that aren”™t too good,” he said.
Dr. Daniel E. Fass, a radiation oncologist in Rye, flew to Washington, D.C. for the president”™s signing ceremony. He and other members of Doctors for America, a national grassroots organization that evolved from Obama”™s presidential campaign as an advocate for health care reform guided by professionals in the field, watched the White House ceremony from an Interior Department auditorium, where they later were greeted by the president.
“I think there is a lot of disinformation about the bill,” he said. Regarding the county medical society”™s claims, he said, “I have yet to see specifics where this will impede patients”™ access to care. That”™s what it”™s really all about. It”™s about patient access, accountability and affordability.”
“We called it the 12-month pregnancy,” Fass said of the legislative process that led to the bill”™s passage. “We went through the labor pains; now we have the baby. As the baby gets older, we”™re going to watch this bill grow. I think once people understand what the bill means for patients, I think they”™re going to be supportive.”
In Yonkers, St. John”™s Riverside Hospital President and CEO James Foy called the health reform bill “important for our country. It”™s good that 35 million persons that didn”™t have insurance will have insurance.”
“I think for physicians it”™s a good thing,” Foy said. “Anything that covers any more people is a good thing. For hospitals, it”™s a much different thing.” For several Westchester hospitals, including St. John”™s Riverside, “It”™s a significant negative,” he said.Â
At the Yonkers hospital, Foy said, well over half of uninsured patients and bad-debt charity cases are believed to be undocumented immigrants. They were excluded from health coverage in the adopted bill. “My understanding is that (immigrant coverage) would have made it dead on arrival in the Capitol,” Foy said.
Instead those undocumented patients will be treated in emergency rooms and are likely to go undetected for contagious diseases. “I think it”™s absurd what we’re doing,” Foy said.
The increase in Medicaid eligibility is not expected to significantly increase the number of insured patients at St. John”™s, he said. And a large proportion of the hospital”™s Medicaid funding will be cut in 2014. “We will be losing millions of dollars a year,” he said.
Kleinman too said the lack of coverage for undocumented immigrants will have an impact in Westchester. “For hospitals, if they”™re not going to get help for that, they”™re in trouble,” he said. With hospitals already losing money and with the prospect of reduced federal funding, “Some of the local hospitals I think might have to close if all of the features of this bill go into effect,” he said.
