Obama Healthcare Reform Bill: Mandatory Healthcare Insurance, Doctor Shortage and Illegal Immigrants

The good news about the healthcare reform bill: we’ll all have healthcare insurance–except illegal immigrants–while, for a large number of Americans, finding a primary care physician will be a nightmare.

Remember Obama and the Dem’s sliding scale of the millions of Americans who don’t have healthcare insurance? The number which, at the beginning of the long healthcare reform “debate”, began at “47 million” who were uninsured then later magically changed to “32 million” without explanation”? What happened to those 15 million who were uninsured? How had they managed to acquire healthcare insurance in the span of a couple of months?

The short answer: They didn’t. And, they’re not covered in the new Obama healthcare reform bill.

I looked into the “numbers game” in August and discovered the 47 million estimate originated from a survey done by the Census Bureau, The Income, Poverty, and Health Insurance Coverage in the United States: 2006. The Census Bureau counts all “residents” including illegal immigrants. After people began to question the 47 million estimate and who was included, Obama and Democrats shifted to the “32 million” uninsured in speeches and town halls. Despite being dropped from the Dem’s rhetoric on the numbers of uninsured, the estimated 15 million uninsured which Obama and Dem’s quit counting in the summer are still out there and will continue to impact healthcare reform including the current primary care physician shortage.

One key provision of the healthcare reform bill–yes, Nancy Pelosi, the bill is out so now “everyone” can see what’s in it–the estimated 32 million of Americans who will, by 2014, be required by law to file proof of healthcare insurance to the IRS. Failure to file the first two years, a $95 penalty. By 2016, the penalties jump to $695 or 2.5% of your income. Missing from the bill: a cap on the amount the IRS can fine or penalize after the year 2016. The other 15 million who Obama dropped in his speeches of the numbers of American’s uninsured: no provisions in the bill they, by law, acquire healthcare insurance.

There’s another number which was rarely mentioned during the dozens of speeches and townhalls by Obama and the Democrats, the estimated 65 million of Americans who live in areas where there is a shortage of primary care physicians. “Shortage” means can’t find a primary care doctor or a clinic of “doctors” willing to take you on as a patient. This is nothing new as several years ago a friend called who was shocked after discovering her long time primary care physician had dropped her as a patient. The reason given: she hadn’t made an appointment in the last six months. Trending upwards for several years, primary care doctors and clinics dropping Medicare patients because the doctors could no afford to treat them due to the government’s low reimbursement rates. As more and more patients enter into Medicare, less providers are willing to accept them as patients. My friend won’t be eligible for Medicare for thirty five years so she wasn’t dumped because she was a Medicare patient.

According to the AP, 16,600 additional primary care providers are needed in areas where primary care providers are scarce. Not in a few years but now. Other sources claim the shortage of primary care physicians is far worse the AP report. The AP writer stated the “surge” for primary care providers wouldn’t begin until 2014 when the “32 million” uninsured are required by law to obtain healthcare insurance.

This still leaves open the questions regarding the other 15 million uninsured who were left out of the healthcare bill, the issue of the shortage of primary care physicians, and mandatory healthcare insurance.

A provision in the bill would provide a 10% Medicare bonus for physicians who would “serve” in those areas. The program would begin in 2011. Will the 10% offered be enough incentive? Those who would be eligible would have to live in areas deemed by the government as having a shortage of physicians. It wouldn’t address the physicians who live in areas not deemed as having a shortage but have already dropped Medicare patients or are opting to drop Medicare patients.

It doesn’t take a crystal ball to see what’s coming down the federal government pike: In the future, the federal government will mandate primary care physicians cannot drop a Medicare patient, even if the cost of treatment drives the physician out of business. The government will also mandate how many patients a primary care physician must treat leading to the government micromanaging the physician’s time spent with patients while dictating who much the government will reimburse the physician. This is most likely to occur within the next decade as the both the number of available primary care physicians and the number of medical students who opt for a career in primary care continue to dwindle.

Here’s a few statistics on the number of physicians in the pipeline:

From Medical News Today:

“The U.S. health care system has about 100,000 family physicians and will need 139,531 in 10 years.” Currently, only about half the necessary number “needed to meet demand” are pursuing this specialty.”

The physicians “in the pipeline”:

“The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). Considering it takes 10 to 11 years to educate a doctor, the drying up of the pipeline is a big concern to health-care experts.”

The proposed 10% Medicare bonus to primary care providers who would move to areas where there’s a shortage would only lend to less primary care providers in other areas. There’s also the questions of whether those who accepted the bonus would eventually be required by the government to take on a mandatory number of patients? Patients who were mandated by the government to purchase health insurance?

Currently, Obama and legislators such as Chuck Schumer and Lindsey Graham propose illegal immigrants pay a fine, undergo a background check and learn English to get a green card then “go to the back of the line” behind current legal immigrants for a Green Card. The newly legal residents will be required to obtain healthcare insurance thus adding the additional estimated 15-20 million to the rolls of the insured, upping the number of those who will be required to have a primary care provider.

There’s no doubt this will be a Democrat selling point for illegal immigration reform. Illegal immigrants now legal, forced to obtain healthcare insurance like the rest of us and lessening the burden on hospitals who currently are required to treat illegal immigrants while, for the most part, absorbing the billions in costs not covered by the state or federal government.

Some Americans may not be happy their access to a primary care doctor would be lessened by the impact of the millions more seeking a primary care physician while there’s an acute shortage which is projected to worsen in the coming years.

Of late, there’s been scant talk on upcoming illegal immigration legislation. If this issue isn’t addressed, wonder how Americans will feel when they realize they have to provide proof of health insurance, pay for health insurance, and find a doctor while another set of an estimated 15-20 million”Americans” are exempt?

Tags: Obama healthcare bill