New Year, New Health Care Plans ... Can Doctors Keep Up?

Thousands of Americans rang in 2014 with new insurance plans under the Affordable Care Act. But will doctors and hospitals start feeling the crunch? Host Michel Martin speaks with Washington Post health reporter Sarah Kliff.

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MICHEL MARTIN, HOST:

I'm Michel Martin and this is TELL ME MORE from NPR News. In a few minutes, we're going to hear about something you might have seen where you live - a lot of teacher turnover, particularly with teachers of color. One young former teacher has written a provocative piece giving her take on why this is happening, and we'll hear what she has to say in just a few minutes.

But first, we want to bring you up to date on some of the developments in the new health care law. With the new year, about 2 million people have been able to sign up for coverage through private exchanges. And also millions of other people got new access to health insurance through expansions in Medicaid. That's the insurance program for the poor. We wanted to find out what comes next if you have that new insurance or if you did not sign up.

So we've called, once again, Sarah Kliff, health policy reporter for The Washington Post. She's with us once again. Welcome back. Thanks so much for joining us once again, and happy New Year to you.

SARAH KLIFF: Yeah, Happy New Year's.

MARTIN: Now you wrote this week that this represents, quote, the most significant change to our health care system in nearly 50 years. That is a very big statement. Just tell us a few reasons why you say that.

KLIFF: Right, so the last time we had an insurance expansion this large was when we created Medicare and Medicaid, which are now really big programs. And what's happening here is essentially in the same scale in terms of how it changes our health insurance market.

For the very first time, starting on Wednesday - on New Year's - anyone can buy health insurance through the individual market. That was not true up until now, and that really is a giant change to how we provide health care. And it's turned the individual insurance market in the United States on its head, really overhauling all the business plans that insurance plans have there.

MARTIN: What if you missed the deadline to get insurance by January 1? What do you do?

KLIFF: You are not out of luck. Open enrollment under the health care law runs until March 31. So you actually have three more months to purchase health insurance. You can't go out today and start shopping and buy a plan that starts today on January 3, but you can buy a plan today that'll start on February 1. So there really is a lot of time left to purchase coverage.

MARTIN: What if you do have this new coverage - by whatever means - I mean, if you have it through Medicaid, if you have it through one of these private exchanges - can you just go out, call up a doctor who catches your eye, who your friends have recommended and see that person? Can you do that?

KLIFF: You can. They might not be covered in your network, and I think this is going to be a big debate that's going to play out over the next few months. We've seen that the products offered through the new exchanges and through HealthCare.gov, they tend to have pretty narrow network, meaning they place restrictions on which doctors they'll pay for.

So while you can go ahead and call up any doctor, you probably want to check if that doctor is in your network and if not, how much you might pay.

And I think we're going to see a lot of stories about people who have purchased coverage who might be either happy with their network and glad to see the doctors they can or frustrated that some of the physicians that their friends see might not be a network and might still be unaffordable despite the fact they have health insurance.

MARTIN: Or might be - or might they be able to see them at all? Because one of the things that occurs, you know, to me, is that if you've got a flood of new people who have access to benefits which they have not had before, presumably they want to use it. And is there a network of providers sufficient to see all these people?

KLIFF: That's a really important question and one we're going to learn a lot more about over the next few months. One thing to keep in mind is that while this is a big insurance expansion - we're talking about 6 million people who gained coverage on Wednesday - it's also a small percent of the population.

That works out to less than 2 percent of Americans gaining coverage. So when I've talked to health policy experts, they say that is a lot of people, but they don't expect, you know, huddled masses sitting outside of doctors' offices just waiting for appointments.

They think there'll be a slight increase in services that people are looking for, but they think that the health care system can handle this relatively small increase in the insurance rate.

MARTIN: Are there other deadlines coming up that people should know about?

KLIFF: There's an important deadline January 10 for anyone who has selected a health insurance plan through HealthCare.gov but has not paid their premium. If they do not pay their premium by January 10, they cannot have coverage that starts on the first.

So that's a very important deadline for anyone who's waiting to make a premium payment. And then the next really key deadline is March 31. That is the very last day you can buy an insurance policy through the Affordable Care Act for 2014. If you don't buy it by March 31, you're waiting until January 2015 to purchase coverage.

MARTIN: And before we let you go, Sarah, I have to ask you about - there's been so much emotion and political heat around this issue, as one might expect. I mean, you've told us just how significant that it is and obviously, a lot of kind of philosophical difference, a lot of political difference being fought out around this issue. How are you going to separate the wheat from the chaff in the months to come?

I mean, clearly there are people who do not support this law, who do not - they don't think it's good policy. They think it's worse politics, and they don't want the law to particularly succeed. And clearly, there are just as many people on the other side who are heavily invested in seeing that it does and then painting the best sort of possible picture.

How do you separate the wheat from the chaff in this and whether the law overall is doing what it was supposed to do and working the way it was supposed to work?

KLIFF: So one thing you have to do is be very patient. We're not going to know even a week from now or even a few months from now if this law is working. It takes a little while to collect data about how many Americans are insured and what kind of access they have to doctors.

I think over the next few weeks, you will see two specific narratives develop, and they'll center a lot on the people getting into the Obamacare system. One will be people who are really happy. They're very excited to see the doctor for the first time.

They've been waiting. And others will be people who are very frustrated, who can't get in to see a doctor, who have been calling. And they find either no doctors will see them or that health care's still unaffordable when they have insurance. And they're going to be very frustrated with the coverage they have. But those are going to be anecdotes, and it's really going to take probably six months and probably even a year for us to understand how happy people are with their coverage.

And even if the insured rate is increasing, one of the things that's actually really difficult to know today is whether more people have insurance than did in December because of all of these cancellations we heard about...

MARTIN: OK.

KLIFF: ...And that's really an issue that will take a while to understand.

MARTIN: Sarah Kliff covers health policy for The Washington Post. She writes Health Reform Watch, and she joined us from the studios of The Washington Post. Sarah Kliff, thanks so much for speaking with us.

KLIFF: Yeah, thank you.

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