http://www.northcoastjournal.com/humboldt/the-faces-of-obamacare/Content?oid=2505643

Only two major insurers are offering policies under the California exchange — Blue Shield and Anthem Blue Cross. When the companies came to negotiate with providers on the North Coast, they took a hard line, as they have throughout the state. Blue Shield offered reimbursements that were 30 to 50 percent less than they would pay doctors under traditional insurance plans, Markle says. Similarly, Anthem Blue Cross offered 10 to 65 percent reductions from its traditional reimbursement levels.

"These are major payers," explains Markle. "They don't have to give you a reason, and they don't have to negotiate. They really kind of backed us into a corner and they wouldn't negotiate. They said, 'take it or leave it,' and we were forced to leave it." It turns out, most providers on the North Coast decided to leave it, unable or unwilling to agree to huge reductions to their bottom lines. "As a business, that's not something we were able to sign on for," Markle continues. "I tell patients, 'equate it to your salary for the year. Would you be able to survive taking a 65 percent pay cut?' The answer is always no."

The situation directly impacts two types of patients. First, there are the newly insured who will be setting out to find a primary care doctor — their "medical home" — and will learn that the only major provider accepting their new insurance is the Open Door Community Health System. Then there are the patients who have long had a primary care doctor but switched to a cheaper Covered California plan, not realizing the Blue Cross or Blue Shield exchange alternative is decidedly different than the plan they gave up. It's this second group that's most frustrating for Markle, as she's the one tasked with telling longtime patients that Eureka Family Practice won't take their new insurance. "I've had patients in tears and patients who are really angry," she says. "It's been awful and I feel terrible for our patients who are put in this position of noncoverage, really."

Charles Minton, a retired RN, said he was stunned when his wife recently enrolled in Covered California, looking to replace her existing catastrophic health insurance (which carries a $15,000 deductible) with an option that was cheaper and covered more services. Minton says she was looking forward to finding her medical home but was turned away again and again as she approached local providers. "Getting it accepted is a whole new thing I hadn't even thought of," Minton says. "Everyone took Blue Cross before."

mor@link