September 20, 2020 Breaking News, Latest News, and Videos

Obamacare Problems: Doctor Shortage, Honor System:

Add between one million and two million persons to the patient load of California doctors. Do not open any new medical schools or import many foreign-trained doctors. It’s a sure-fire way to create a doctor shortage – and just where California is headed right now.

That’s probably the most severe problem the Patient Protection and Affordable Health Care Act, often called Obamacare, faces in California when it becomes fully active Jan. 1, but it’s hardly the only one. There are insurance companies refusing to write policies for some small businesses. And how about the fact that the federal government at least for the first year of the program will not demand any kind of proof that people actually qualify for subsidies designed to make health insurance affordable to almost everyone.

Instead, a kind of honor system may be in effect. “For income verification, for the first year…, we are providing exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification,” says a rule officials just inserted into the Federal Register.

This applies to states like California that have their own insurance exchanges, although the Covered California exchange says it might still demand pay stubs or their equivalent from clients. “That’s always been our plan, but since verification is now not required, we’re looking at our options,” said spokesman Dana Howard.

Which means that rule could cost billions in fraud if some of the newly insured lie about their income and don’t get caught.

But the impending doctor shortage could actually be life threatening, making it the most severe problem that Covered California might face next year.

Take the example of Orange County. California’s second-largest county will see as many as 280,000 persons now without health insurance suddenly become eligible next year. That includes new Medi-Cal patients previously ineligible because they were childless or had too high an income. A single adult can now get Medi-Cal with an income of 138 percent of the federal poverty level, or $15,856.

Most will probably go to clinics for their primary care. But will those clinics have the personnel to take care of them? In Orange County alone, a population almost as large as Fresno’s will suddenly be entitled to care, but there will be virtually no new doctors.

That’s one reason for the steady progress through the Legislature of several bills giving non-physicians more authority to perform some types of medical care.

These would let pharmacists, nurse practitioners, optometrists, physician assistants and nurse midwives perform some functions now reserved for medical doctors.

“Pharmacists are the most underused of health professionals, considering their years of education and training,” says Democratic state Sen. Ed Hernandez of West Covina, author of the most sweeping bills to let non-doctors perform more medical functions.

Many pharmacists no longer spend most of their time counting pills or filling medication bottles. Technicians and automated pill counters can do those things. Instead, many pharmacists now spend significant time counseling patients on possible drug interactions when one doctor writes a prescription without knowing what another has already written. Pharmacists also often ask patients about their ailments and advise which drugs might work best for them.

Hernandez’ bills would let pharmacists prescribe birth control pills, vaccines and some other types of medication on their own. He contends they already do a lot of that, de facto, but doubts remain. Would pharmacists, for example, know what vaccines are appropriate for organ transplant recipients?

The long-term answer to the physician shortage is to set up more medical schools and train more doctors. But since Medicare, Medi-Cal and other programs have gradually cut fees they pay, an M.D. degree may no longer be an automatic ticket to wealth and medical schools could have trouble attracting the top students they traditionally have.

There’s also the small matter of how long it takes to train a doctor – 10 years or more for some specialists. So it will be awhile before the doctor shortage is overcome, and despite opposition from the California Medical Assn. and many physicians, this means somebody besides doctors will have to provide some of the care for the newly insured. Like it or not, comfortable or not with non-physicians making some medical decisions, that’s the coming reality.

Related Posts

COVID-19 Could Have Been in Area as Early as Last December

September 15, 2020

September 15, 2020

UCLA study reports significant increase in coughs and acute respiratory failure prior to first official cases of COVID-19 By Sam...

County Walks Back Trick or Treating Ban

September 9, 2020

September 9, 2020

Department of Public Health now says trick or treating not recommended By Sam Catanzaro County health officials have walked back...

Trick nor Treat: LA County Bans Door to Door Trick or Treating

September 9, 2020

September 9, 2020

Update: the Los Angeles County Department of Public Health has revised its Halloween guidelines. Previously, as reported below, officials planned...

Edify TV: LA County Salons Given Green Light

September 8, 2020

September 8, 2020

Barbershops and hair salons in Los Angeles County have been given the green light to reopen with restrictions in place...

UCLA Searching for COVID-19 Vaccine Volunteers

September 8, 2020

September 8, 2020

Editor’s note: this AstraZeneca’s COVID-19 trial is on temporary hold while the company looks into whether a patient involved in...

Worst Housing Bills Fail; Solution via Market Forces Now Possible

September 4, 2020

September 4, 2020

By Tom Elias, Columnist Evidence keeps mounting that California’s longtime housing shortage can be solved by market forces set loose...

SMa.r.t. Column: Budget Reform and the New Normal

September 4, 2020

September 4, 2020

Our guest columnist this week is Marc L. Verville. He is a native of Santa Monica, now lives in Sunset...

Ahead of Labor Day County Warns COVID-19 Progress Could Be Hampered

September 1, 2020

September 1, 2020

Seven-day positivity rate currently below 5 percent By Sam Catanzaro Despite optimism regarding COVID-19 transmission rates, ahead of Labor Day...

New Santa Monica Senior Affordable Housing

September 1, 2020

September 1, 2020

Greenway Meadows development nears completion A new development near completion in Santa Monica will provide 38 apartments to low-income seniors...

Montalvo on Montana’s ‘Boos Boos LA’ Cotton Masks

September 1, 2020

September 1, 2020

By Staff Writer In light of the growing need for personal protection equipment, a local company is getting creative with...

County Can ‘Think About’ Reopening Schools, Businesses if Transmission Rates Hold

August 25, 2020

August 25, 2020

Community spread still needs to decrease, officials say By Sam Catanzaro Los Angeles County’s head of public health noted at...

My Dog Day of Summer

August 24, 2020

August 24, 2020

I usually don’t sweat the news about temperatures.  I live on the Westside, close to the Pacific Ocean, and it...

Column: How to Play it Safe to Prevent Deadly Heat Exhaustion

August 24, 2020

August 24, 2020

By Shawn McCann  As the Southland region broils in a summer heatwave, the coronavirus pandemic has created additional concern for...