I was stunned when I read Jerome Connolly’s editorial “is Obamacare working?” in the February Impact. It only took reading the second sentence to see that it was going to be a biased promotion of the Affordable Care Act. I am indignant that our association’s advocacy lobbyist is pulling for legislation that has categorically harmed the private practitioner. The PPS should be more sensitive to the impacts of this law on practice owners, and to writers making comments such as “for Republicans, the goal is to bolster GOP prospects [in the 2014 or next year’s ]Congressional elections by vilifying the health care reforms.” Irrespective of political intentions, the legislation is not favorable to private practitioners. As employers, many of us are getting whacked with huge medical premium increases. More so, as providers we are seeing significant declines in referrals due to exorbitant patient deductibles and copayments, and individuals either losing their insurance, or unable to afford their contribution. We are also uncertain of how we can participate in the accountable care organizations (ACOs) and medical homes. I fear the laws incentives toward horizontal and vertical integration will shut us out on the market. We are being told to “diversify” to stay competitive. I always thought my expertise made me diverse. Now, ACOs may push me aside in favor of hospital-owned physical therapy facilities. One of the APTA’s legal counsel sent me an e-mail stating “I fear that ACOs will be the nail in the coffin of the private practitioner.” Finally, it appears any saving so far have come out of our pockets, which is not something that I feel like applauding and cheering for.
With so many of the law’s provisions suspended by the president, common sense tells us that the law, beyond the website itself, has its flaws at best, and is a disaster at worst. To say that the law is responsible for reducing costs is simply erroneous. The vagaries of this law has confused, confounded, and complicated insurance companies, employers, and health care providers in planning, developing, implementing, and sustaining healthcare coverage at a level that is understandable, predictable, and profitable. In other words, no one knows what to expect, how to plan, or how to act. That is never good for business.
Mr. Connolly’s bullet points in my opinion, do not provide one salient or relevant point as to how the Affordable Care Act benefits private practice physical therapists. Rather, they resemble political talking points. Quoting Paul Krugman (who thinks that the “economy has stabilized”) as a reliable reference source, while labeling O’Reilly, Krauthammer, and George Will as “critics” reveals Mr. Connolly’s political bias.
Mr. Connolly asks “so, are Obamacare’s insurance reforms, health care delivery system, and coverage provisions making health care more affordable?” Let me give Mr. Connolly a straight answer, and one not as euphemistic as “bending the curve.” No, it is not. Real spending per Medicare recipient has declined because of sequestration, not the ACA. Also, the employer-provided insurance market has been moving toward higher deductible plans and higher copayments for several years, which is more likely responsible for the slowing of health care spending. If you cannot afford to use the system, utilization declines and consequently, costs go down.
The February 4, 2014, Congressional budget Budget Office (CBO) report predicted a 2.3 million loss in job full-time equivalents by 2021. Furthermore, rises in health care costs have not slowed as Krugman asserts, unless you are talking about reimbursements to private practice physical therapists. The CBO last month estimated that the ACA would cost an unexpected and unaccounted for $1 trillion. CNBC poll last week showed 41 percent of employers froze hiring due to the ACA. Insurance companies have not taken a hit financially, but continue to achieve projected quarterly profits. Most have fluffed their cushions over the last three years by increasing premiums and decreasing reimbursements to providers, in anticipation for the effects of Obamacare. Additionally, there are third-party administrators, such as Orthonet employed by Cigna, cutting in on the providers’ contracted reimbursement amounts to provide services that benefits only the insurance company. Orthonet’s corporate net worth increased by millions in 2012. My reimbursements dropped 4 percent the same year. At least this health care provider is not to blame for rising costs.
Many of us were opposed to the law from the start for various reasons, but there are others in our section who supported it. That’s America—we don’t all agree on these types of things. But rather than cheerleading for the law and offending about half of us, we would prefer the PPS lobbyist work on ways to help therapists thrive in the challenging marketplace and write articles in Impact about what is specifically being done in that area to protect and promote our interests. Articles like this one, further reduce my confidence that our PPS leadership is fully tuned in to what is happening among private practice owners.
Jack A. Parry, PT, DPT, MSA
Owner, Parry PT Group
Response from Jerome Connolly
Dr. Parry’s perspectives on my February column are welcome. As the lobbyist for PPS, I appreciate hearing from members who face the day-to-day challenges of running a successful practice.
Also as your lobbyist, I do not defend nor condemn the Affordable Care Act (ACA), and I work every day on behalf of PPS members to improve the environment for private practice. The advocacy plan that we are carrying out on Capitol Hill is devised and overseen by the Section’s Board of Directors and Government Affairs Committee.
The February column was not an opinion piece, but rather a presentation of the discussion of Obamacare that is taking place in media, economic, and news circles throughout the country. The column endeavored to present bipolar answers to the question: “Is Obamacare working?” Seven references were cited, the majority of which took issue with the claim that the law is having beneficial effects.
There is no question that the four-year-old law has created challenges for health care providers—private physical therapy practitioners included. But not all of them are attributable to the ACA as many of the problems facing us as private practice owners preceded the adoption of the ACA; double-digit premium increases, increased deductibles and copayments, growing number of uninsured, arcane sustainable growth rate formula, multiple procedure payment reduction, therapy caps. Nevertheless, PPS is committed to being an active, vocal and effective force in the advocacy space on behalf of its member.
As I stated in the column, “the debate over the success or failure of the ACA persists and, like beauty, appears to be in the eye of the beholder.” The law has divided the country and, according to the Kaiser Family Foundation’s latest poll, remains opposed by more people than it is favored. But it is the law and, even if it were to be repealed, the changes to health delivery that have been put in motion are not likely to be reversed as easily.
As long as these issues exist, and even the nation’s governors—both Republican and Democrat—suggest that the health care overhaul is here to stay, I believe it is beneficial that your Washington lobbyist help describe the elements of the debate and the overarching arguments that continue to affect our individual delivery methods.
Principal, Connolly Strategies & Initiatives
Registered Federal Lobbyist