Docs dissect good, bad of Obamacare

Feb. 01--Dr. Richard Declusin would keep the mandate forcing insurance companies to cover cancer, diabetes and other pre-existing conditions.

The Oxnard heart surgeon who voted for Donald Trump is also OK with protecting the provision that allows young adults to stay on their parents' insurance plan until age 26 though he thinks finding a job could be the better option.

He argues nearly every other part of the Affordable Care Act should go.

"Deductibles are way too high," he said, pinpointing access to care as one of the reform law's biggest flaws. "Yes, they have insurance but they can't use it."

Republicans led by Trump promise to repeal and replace the Affordable Care Act, perhaps protecting pre-existing conditions and insurance for young adults. A national survey of 426 primary-care doctors showed 15 percent of them want to repeal the law in its entirety, from its mandate that nearly all people be covered or face fines to marketplaces that offer subsidized insurance for people who meet income standards, including more than 31,000 Ventura County residents.

At least 56,000 more county residents are covered through the law's expansion of the Medi-Cal insurance program for low-income people.

In the post-election survey published this year in the New England Journal of Medicine, 74 percent of the doctors did not want a repeal but wanted changes. Their proposals vary, but range from tax credits to allow people who qualify for Medi-Cal to buy private insurance to starting a government-funded public option that might be similar to Medicare.

More than 32 percent of the Republican doctors surveyed wanted to repeal the entire law. Not one of the Democrats wanted a repeal.

The Ventura County Star asked area primary-care doctors and specialists to weigh in on the reform law and what parts of it should stay and what should change.

Dr. Josephine Soliz, an Oxnard family physician, wants parity. She said primary-care doctors may get paid as high as twice as much for an office visit in a private plan outside of the Affordable Care Act, compared to a plan bought through Covered California. She said the inequities contribute to access issues that create "enormous problems" in referring Covered California members to specialists.

Co-pays in some of the lowest-priced or bronze plans are so high they can block patients from anything but catastrophic care, she said.

Soliz, who voted for Hillary Clinton, does not want to see the Affordable Care Act repealed. She worries taking away the law will bring back the days when people could be denied dialysis and other desperately needed care. She worries, too, that doctors won't know the full impact of a repeal because they won't immediately know who is blocked from coverage.

"We'll just see the people who come in," she said.

Dr. Irving Loh, a Thousand Oaks cardiologist who has been involved in health care reform since the 1990s, contends that many doctors are swayed by politics, the specter of more government regulation and insurance reimbursement.

"It always gets down to power and money," said Loh, who wants to increase access to care by expanding physician networks in plans bought through the reform law. He supports adding a public insurance option that would compete with private insurers.

"What you don't want to do is toss the whole thing out," he said of the Affordable Care Act, arguing a goal should be to provide the same kind of insurance offered to members of Congress.

"They need to develop a health plan they're willing to have," said Loh, who voted for Clinton. "If it's good enough for the public, it should be good enough for Congress."

Dr. Lee Wan, an Oxnard eye surgeon who voted for Libertarian candidate Gary Johnson, contends the Affordable Care Act has little impact on how much time doctors spend with their patients and the care provided. He worries more about the Medicare Access and CHIP Reauthorization Act. The act is designed to pay doctors for the quality of care given to Medicare patients rather than quantity and includes a litany of regulations -- what Wan called boxes to check off. He said the regulations can interfere with patient care.

"I would get rid of a lot of it," he said of the act. "Most of it is wasted work. It's wasted effort. It does nothing to improve care."

Dr. Kenneth Finger, who voted for Clinton but wanted Bernie Sanders, treats patients at a Las Islas Family Medical Group in Oxnard that serves as a safety net. When he thinks of the Affordable Care Act, he focuses on five of his patients, all men, who sought care because of the insurance the new law brought. They were each diagnosed with diabetes.

He said he knows what will likely happen to the five men in a repeal.

"They will stop getting medications. They will stop being treated. They will have a crisis. They will end up in the emergency room," he said.

Dr. Lorne Label, a Thousand Oaks neurologist, calls himself a political independent and said his choice for president is private. He said the Affordable Care Act is a good plan that was unfortunately shaped by the insurance industry. He paused when asked to identify the aspect of the current system that most needs to be changed.

"If I had one thing to do it would be to eliminate the middle man called the insurance companies," he said.

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