Forget the lawsuits — the real threat to the Affordable Care Act is a looming doctor shortage. It's not just that more and more doctors are quitting the business, it's also that more and more practices have stopped accepting Medicaid (and Medicaid expansion is a key component of the ACA).
The result could be an attempt by the Obama administration to force doctors to accept Medicaid patients — what some are now calling a "doctors' mandate."
"John Foust, a Democrat running for the 10th congressional seat in Northern Virginia, is — like Gov. Terry McAuliffe and other state Democrats — gung-ho to expand Medicaid," writes Bart Hinkle of the Richmond Times-Dispatch. "His wife's position is, shall we say, a bit more nuanced."
Foust's wife is a physician whose practice doesn't accept Medicaid.
"This draws attention to an under-covered aspect of the debate over Medicaid expansion," Hinkle writes. "While advocates speak of it as ‘making health care available' to the needy, what it really does is make coverage, rather than care, available to them. A newly enrolled Medicaid patient can get the money to pay a doctor. But can she get the doctor to take it?"
Could a "doctor's mandate" be the Obama administration's remedy? Hinkle points out the ACA already imposes lots of mandates on other sectors of the health care industry. Insurance companies and pharmaceutical firms already face a whole slate of new rules.
"Forcing doctors to accept Medicaid patients would be an obvious, logical extension of these trends," Hinkle writes. "If insurance companies can't turn people away, then why should physicians be allowed to? If drug companies can't charge more than people can afford, then why should doctors? So far, no elected officials have yet proposed reining in the limited liberty that doctors still enjoy. But such proposals could very well come, one of these days."
This trend will be exacerbated by the larger trend of fewer doctors for more patients. Many physicians are leaving the profession.
"Eighty-three percent of American physicians have considered leaving their practices over President Barack Obama's health care reform law, according to a survey released by the Doctor Patient Medical Association," the Daily Caller reported last year. "The DPMA, a non-partisan association of doctors and patients, surveyed a random selection of 699 doctors nationwide. The survey found that the majority have thought about bailing out of their careers over the legislation."
Even if not a single doctor quits, the U.S. will face a shortage of at least 90,000 doctors by 2020, the government estimates.
Five years after that, the shortage will be 130,000.
This could very well drive a "doctors' mandate," Hinkle warns. And that would be bad for the country.
"Treating private enterprise as a conscript in service to the State is a philosophy with an ugly lineage," he writes. "In liberal democracies, government is supposed to be the servant — not the master. In health care, however, the relationship is growing increasingly inverted."
The shortage is coming (indeed, in many places it's already here).
Now we wait for the Obama administration's "solution."