12/14/2017    Bryan Markinson, DPM

Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)

Dr. Lang seems to intimate that it is obvious
that podiatry as a profession is better off with
the ACA mandate requiring the purchase of health
insurance. I am not so sure. My vantage point is
from an academic medical center based practice
which is full time private practice and part time
hospital clinic practice. The private SPECIALTY
practices largely do NOT participate with most
plans offered on the health exchange, which is
also true of most of the community-based
podiatrists (this is a supposition that I cannot
verify).

The specialty clinics largely do participate with
the exchange plans, which seem to be nothing more
than a glorified form of Medicaid. Because of
this, the specialty clinics are becoming flooded
with patients who used to have good commercial
insurance and now are "insured" on the exchange
and have nowhere else to get care. This is the
trend that I observe.

So, it’s somewhat unclear what the effect of
"millions of patients" uninsured will be if the
mandate goes away. If we are not accepting those
plans in the first place, I don't see the loss as
so great. As patients in all stratifications of
wealth are becoming more used to paying more for
services, podiatrists in private practice have a
choice to make to better distinguish or boutique
themselves OR join multi-specialty groups as
employees and make a guaranteed $160,000.00
dollars a year with great benefits. Depending on
who you are and your life choices, both can be
professional Nirvana. But toiling away at 40 or
more patients a day and struggling to pay the
bills is unsustainable economically and mentally.

Bryan C. Markinson, DPM, NY, NY

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12/14/2017    Judd Davis, DPM

Will eliminating the ACA mandate help podiatry? (Joel Lang, DPM)

I must respectfully disagree with Dr. Lang's
assessment of the ACA. Since he is retired I
suspect he is not seeing the reality of the ACA
in a private practice setting. I am one of the
34% who feel the ACA has been a massive failure
for the following reasons:

1) Most of the ACA plans have huge deductibles,
essentially providing catastrophic coverage only.
Many of the people who sign up for these plans
are completely unaware of this and surprised to
find their entire office visit went to their
deductible for which they are responsible. They
may or in some cases may not pay their provider
for the services rendered.

2) Many of the ACA commercial plans have
extremely narrow provider networks. Some of the
plans in my town are only contracted with 2 or 3
podiatrists in the whole city. Again they are
frequently unaware of this and call to schedule
appointments thinking they can see any provider
that takes XYZ insurance plan. This creates a
huge problem for scheduling staff trying to sort
through and screen these patients out.

3) Of the millions of people who got insurance
through the ACA, my question is how many were
dumped into the Medicaid system? Again this is
essentially catastrophic coverage only. Medicaid
pays podiatrists so poorly in my town that next
to no one even takes it. So essentially those
patients have no coverage here or have to wait 4
months for an appointment or travel to a
different city for treatment. I lose money on
Medicaid and cannot stay in business that way.

4) Finally, my insurance premiums have
skyrocketed for my personal health insurance,
going up every single year. Mine has doubled in
cost in the last 10 years. I would bet that is
the case for most people who have commercial
insurance plans. The ACA was supposed to lessen
the cost of healthcare for everyone. It has had
the opposite effect, a complete failure. A recent
article I read stated that the average cost of
healthcare for a family of 4 is $17,000/year now.
That is UNAFFORDABLE and unsustainable for most
middle class Americans.

Judd Davis, DPM, Colorado Springs, CO