States that require hospitals to accept Obamacare insurance

[HereWeGo21]

I know that in Maryland, teaching hospitals are required to accept all insurance policies sold on the Obamacare exchange. Any other states have this rule? Any chance hospitals will someday be forced on a widespread scale to accept Obamacare insurance/Medicare/Medicaid?

Is it just me, or will policies like this bankrupt hospitals/drive doctors out of medicine?

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[Pacna]

It will do what policies like these always do: Create odd loopholes that people will be exploiting. As you suggest, there's no way controlled payments are going to satisfy the expenditures of hospitals/clinics, and they would go bankrupt if they only took that form of payment. As it stands today (or before implementation of the ACA), most surgical practices lose/lost money on medicare/medicaid patients. Their income comes from private insurance.

What are the loopholes going to be? I haven't a clue, but bet your butt docs aren't just going to pack up and leave.

 

[DokterMom]

I know that in Maryland, teaching hospitals are required to accept all insurance policies sold on the Obamacare exchange. Any other states have this rule? Any chance hospitals will someday be forced on a widespread scale to accept Obamacare insurance/Medicare/Medicaid?

Is it just me, or will policies like this bankrupt hospitals/drive doctors out of medicine?

Obamacare insurance? WTF? (Let me guess - Fox News?)

OK, the difference between "Obamacare insurance" and the other kind (the kind that people are losing now) is that the insurance policies that comply with the ACA regulations are prohibited from containing the kinds of loopholes and exclusions that denied patients coverage for things the insurance company could claim were 'pre-existing' or 'excessive' or beyond 'reasonable and customary'. Reimbursements to hospitals might be smaller for some insurance plans, but they would exist. The hospital would be reimbursed for care to a patient who has insurance -- UNLIKE many of today's plans that do not reimburse hospitals at all (because of some loophole or another) or that cover "the first $100" only, leaving the rest to the patient.

You know what happens under the current (pre-ACA) system? A patient hits the emergency room for a necessary but relatively minor issue -- say a few stitches. If that patient has good insurance, the patient pays $50 or $100 and the insurance company pays the hospital $1,500 or so (a rate pre-negotiated between plan and hospital) and that's that. The hospital isn't going broke on those $1500 reimbursements. If that same patient has no health insurance or a crappy policy, the hospital bills the insurance company (and/or patient) $10,000 or so (no pre-negotiated discount, remember?), the insurance company pays $100 or so (after 120 days) and the patient gets billed for the rest. The patient can't possibly pay it ($10,000 for stitches!?), doesn't pay (or pays only a small portion), and the hospital writes off $10,000 as noncollectable "Charity" care and claims to be such a good community citizen, providing [inflatedly overpriced] care to the indigent.

Medicaid reimbursement rates are low. From what I hear, too low to allow doctors & hospitals to treat medicaid patients profitably. No argument there.

Medicare reimbursement rates are set based on 'demonstrated cost' formulas, so by design, they are adequate to allow the system to make what the government considers to be a reasonable profit. Hospitals seem to agree, since where-ever you find old people (the ones on Medicare), there are always plenty of hospitals. Sure, some procedures are under-reimbursed, but there are others that are over-reimbursed. No program is perfect.

The Time Magazine article about healthcare billing should be required reading for every med student.

http://content.time.com/time/covers/0,16641,20130304,00.html

 

[HereWeGo21]

Obamacare insurance? WTF? (Let me guess - Fox News?)

OK, the difference between "Obamacare insurance" and the other kind (the kind that people are losing now) is that the insurance policies that comply with the ACA regulations are prohibited from containing the kinds of loopholes and exclusions that denied patients coverage for things the insurance company could claim were 'pre-existing' or 'excessive' or beyond 'reasonable and customary'. Reimbursements to hospitals might be smaller for some insurance plans, but they would exist. The hospital would be reimbursed for care to a patient who has insurance -- UNLIKE many of today's plans that do not reimburse hospitals at all (because of some loophole or another) or that cover "the first $100" only, leaving the rest to the patient.

You know what happens under the current (pre-ACA) system? A patient hits the emergency room for a necessary but relatively minor issue -- say a few stitches. If that patient has good insurance, the patient pays $50 or $100 and the insurance company pays the hospital $1,500 or so (a rate pre-negotiated between plan and hospital) and that's that. The hospital isn't going broke on those $1500 reimbursements. If that same patient has no health insurance or a crappy policy, the hospital bills the insurance company (and/or patient) $10,000 or so (no pre-negotiated discount, remember?), the insurance company pays $100 or so (after 120 days) and the patient gets billed for the rest. The patient can't possibly pay it ($10,000 for stitches!?), doesn't pay (or pays only a small portion), and the hospital writes off $10,000 as noncollectable "Charity" care and claims to be such a good community citizen, providing [inflatedly overpriced] care to the indigent.

Medicaid reimbursement rates are low. From what I hear, too low to allow doctors & hospitals to treat medicaid patients profitably. No argument there.

Medicare reimbursement rates are set based on 'demonstrated cost' formulas, so by design, they are adequate to allow the system to make what the government considers to be a reasonable profit. Hospitals seem to agree, since where-ever you find old people (the ones on Medicare), there are always plenty of hospitals. Sure, some procedures are under-reimbursed, but there are others that are over-reimbursed. No program is perfect.

The Time Magazine article about healthcare billing should be required reading for every med student.

http://content.time.com/time/covers/0,16641,20130304,00.html

Thanks for your reply. I realize that many pre-ACA policies are incomplete and provide weak coverage. I'm not denying the necessity of the ACA requirements.

I was simply wondering which hospitals are required to accept ALL policies sold on the ACA exchange by state law, and which hospitals are allowed to choose which policies they accept. I've read that most top hospitals accept only 1-2 of the ACA exchange policies, except for Hopkins, which is forced to accept all of them because of state law.