This story is part of a partnership that includes , and Kaiser Health News. It can be republished for free. (details)

On a recent afternoonÌýat his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way.

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.

That’s not something he’s willing to accept.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Three insurers offered plansÌýonÌýConnecticut’sÌýACA marketplaceÌýin 2014, andÌýGerard is only accepting one. He won’t say which, but he will say it pays the highest rate to doctors.

“I don’t think most physicians know what they’re being reimbursed. Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

Gerard’s decision to reject two plans is something officials in Connecticut are concerned about. If reimbursement rates to doctors stay low in Obamacare plans, more doctors could reject those plans. And that could mean that people will get access to insurance, but they may not get access to a lot of doctors.

That worries Kevin Counihan, who runs Connecticut’sÌý.

“I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care,” Counihan says.

The Connecticut insurance exchange, Access Health CT, has opened retail storefronts like this one in New Britain, Conn. (Photo by Jeff Cohen/WNPR)

His agency recently approved rules geared at getting more providers into plans on the exchange. The goal is to make sure that everyone gets good care regardless of their income.

He doesn’t want the impression left that someone who gets a subsidy to buy ACA coverage will get inferior care. “That’s been something, at least in our state, that we’re trying to work against. And the carriers are, as well,” Counihan says.

All three of the insurers on Connecticut’s exchange were asked to comment. Two declined. One agreed. Ken Lalime is the CEO of Healthy CT — an insurance co-op. He says insurers face a real challenge figuring out how to pay doctors enough but also keepÌýconsumer premiums low.

“Every time you increase payments to providers, you have to offset that with increased reimbursements from the consumer,” says Lalime. “So there’s this balance between how much do you want to cost to provide that service and how much you can pass along in your premiums rates. It’s a balancing act.”

Healthy CT may have missed the balanceÌý– just 3 percent of the exchange’sÌýconsumers bought the co-op’s insurance in 2014. Lalime says he also thinks low reimbursement rates are forcing some doctors to decide against accepting insurance under the Affordable Care Act.

Dr. Bob Russo is sure of it. He’s a radiologist and he’s also the president-elect of theÌý. He says that the low rates and administrative burdens that come along with the ACA could make it a financial loser.

“You get what you pay for,” Russo says. “If you can’t convinceÌý[doctors] that they’re not losing money doing their job, then it’s a problem. And they haven’t been able to convince people of that.”

He, like Counihan, worries about creating a tiered health care system. He says, think about Medicaid. Before a recent rise in rates, it paid doctors even less than Medicare, so many stopped accepting Medicaid patients.

“There’s no question that Medicaid, under its old rates, wasn’t working. So, have we just invented a new Medicaid that kind of slid the scale up a little more to make access a little more?” Russo says.

The experience of these doctors is a good reminder that the Affordable Care Act is more than a thought exercise in health care. It’s happening. And here’s another reminder: open enrollment for 2015 begins inÌý.

This <a target="_blank" href="/health-industry/a-doctors-perspective-on-obamacare/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

There’s one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up.

“So, it’s just about 10 o’clock when we open up, and we’re just starting to see lines forming for people coming in as soon as we open,” he says.

Access Health CT opened the first retail storefront for a state exchange in New Britain, Conn., in November (Photo by Jeff Cohen/WNPR).

That’s become normal, he says, as the March 31 deadline for enrolling in Obamacare approaches. With just days to go, Connecticut’s exchange, , has done a than most states at enrolling people who are eligible. Strategies such as opening a retail store like this one may have played a role in that.

A few dozen people have come to check out their health insurance options. Debra White, 63, pays $300 a month to cover herself and her husband. That’s about a quarter of her monthly income. She can manage. But it’s not easy.

“I do have insurance, but I’m coming to see if I can lower the payment because I’m on a fixed income,” she explains.

Many say what drew them in was the idea of signing up for insurance in person — not on the phone, not on the computer, nor the smartphone.

“It makes it easier for me to converse with another person,” White says. “When I’m on the computer and everything, it’s confusing. Frustrating. Especially this time. I had a stroke, so at this time in my life it’s a little difficult.”

White is here with her grandson, Robert Taylor, 21. He works retail part time, and he goes to community college. He doesn’t have insurance at all and he’s here to get it.

“I’m healthy and I really don’t make too many trips to the doctors,” he says. “It’s just, when I do, I’d like to have a different way of paying for it other than coming out of my pocket.”

Michelle Perez is next in line for someone who speaks Spanish. She says she’s here to figure out if the new health insurance law can help her save some money. She’s holding a medical bill for a recent doctor’s visit. She’s diabetic and unemployed. And she’s here so someone can explain her options to her.

Also waiting for a broker is DeLisa Tolson. She lost her insurance when she got divorced three years ago. Since then, she’s gone to the emergency room and to mobile health vans for care.

“Even though they did a lot for me on the medical van, there were just some things they just couldn’t do,” she says. “And so, as far as mammograms and Pap smears, and being over 40, I decided it was time that I came down here and got Access Health.”

That was three weeks ago. Starting April 1, she’ll pay $86 a month for her insurance. That’s a lot better than the roughly $240 a month she had priced before the exchange plans were available.

Today she’s back, bringing a friend in to enroll.

“I came home and I explained to … all of my friends how easy it was and how comfortable it was,” Tolson says. “It didn’t take long at all, either. I was in-and-out within like 45 minutes to an hour. I felt very welcome. It was a very warm environment. It was nice.”

The state’s health care exchange says that Tolson is one of 10,000 people to have walked into one of its two retail stores — and that she’s one of 5,000 to have actually enrolled.

This story is part of a reporting partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/insurance/connecticut-retail-store-rush-for-insurance/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

He’s the associate dean of admissions choosing the first class of a brand new medical school, the Frank H. Netter MD School of Medicine at Quinnipiac University in Connecticut. It’s a school with a very specific mission: minting new doctors who want to go into primary care practice.

“We have over 1,600 applicants, and we will interview 400 applicants for 60 spots,” Ellison says.

Under the Affordable Care Act, millions more people with insurance may be headed to the doctor’s office.ÌýThat means the medical system will need more doctors, nurses, physician assistants and other healthcare workers to meet the demand.Ìý Quinnipiac is spending $100 million on the new school, and it is one of about a dozen new medical schools on the horizon.Ìý A few of these new schools will also be focused on primary care.

The Netter School’s new dean, Bruce Koeppen, runs through the many reasons why new physicians don’t choose primary care: They don’t make as much money as specialists; they have to know about everything from the common cold to severe depression; and primary care physicians don’t always get the respect that specialists do.

To tackle these challenges, Koeppen says it’s important to admit the right students to the program. He cites demographic data that show who is more likely to choose general medicine.

“Turns out that women are more likely to go into primary care than men. Individuals who are coming to medicine as a second career are more likely to go into primary care,” Koeppen says.ÌýÌýÌý

David, a 35-year-old pharmacist who has applied for the fall semester, fits into that second category.Ìý(He asked that we not use his last name, because his employer doesn’t know he’s thinking of a career change.)

In his interview with Ellison, David described wanting to have a greater impact on patients’ lives, such as calming a child who is anxious during an exam or bringing a patient’s heart rhythm back in an emergency. “These moments weren’t available to me within the context of pharmacy practice,” David said.

In addition to career changers like David, Koeppen says students who are first in their families to go to college and students who’ve come from medically underserved areas are more likely to pursue primary care.

Henry Sondheimer of the Association of American Medical Colleges says that it’s good to be clear with your applicants on the front end.

“To the extent that you clarify your mission to your students who apply and, most importantly, when they interview, so they get to see what you’re doing and what you’re looking for, then you will find the students who will fit your mission,” Sondheimer says.Ìý“This is not for show.Ìý I think this is a very important, and very serious, effort by these schools.”

The question is, can it work?

Kevin Dorsey says it can and it does.Ìý He’s the dean of the Southern Illinois University School of Medicine in Springfield, Ill. ÌýHis school started in the 1970s with a specific mission that still guides it – the school wants students who will stay in central and southern Illinois when they graduate, because that part of the state needs doctors.

“I think we take, through a holistic admissions process, people that we think would be a good fit for this region,” Dorsey says. “They are of and from the region, they know the values of the area, we train them here, and they gravitate back.”Ìý

Southern Illinois designed a curriculum that gives prospective doctors hands-on, local experience.

“These students are farmed out back to local communities to work with a family medicine physician in that community, and so they eat, drink and sleep family medicine for about a month,” Dorsey says.

That’s a strategy that Quinnipiac also aims to try – in part by sending its students out regularly to spend a day with primary care doctors.ÌýAnd Koeppen says he hopes that strategy works, because he’s got an ambitious goal.ÌýNationally, about a third of graduating doctors go into primary care and stay there; Quinnipiac’s goal is for 50 percent of its graduates to stay in primary care.

This story is part of a collaboration that includes , and Kaiser Health News.

This <a target="_blank" href="/health-industry/quinnipiac-medical-school-primary-care/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

This story is part of a partnership that includes , and Kaiser Health News. It can be republished for free. (details)

On a recent afternoonÌýat his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way.

For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates.

That’s not something he’s willing to accept.

“I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates,” Gerard says. “You have to maintain a certain mix in private practice between the low reimbursers and the high reimbursers to be able to keep the lights on.”

Three insurers offered plansÌýonÌýConnecticut’sÌýACA marketplaceÌýin 2014, andÌýGerard is only accepting one. He won’t say which, but he will say it pays the highest rate to doctors.

“I don’t think most physicians know what they’re being reimbursed. Only when they start seeing some of those rates come through will they realize how low the rates are they agreed to.”

Gerard’s decision to reject two plans is something officials in Connecticut are concerned about. If reimbursement rates to doctors stay low in Obamacare plans, more doctors could reject those plans. And that could mean that people will get access to insurance, but they may not get access to a lot of doctors.

That worries Kevin Counihan, who runs Connecticut’sÌý.

“I think it could lead potentially to this kind of distinction that there are these different tiers of quality of care,” Counihan says.

The Connecticut insurance exchange, Access Health CT, has opened retail storefronts like this one in New Britain, Conn. (Photo by Jeff Cohen/WNPR)

His agency recently approved rules geared at getting more providers into plans on the exchange. The goal is to make sure that everyone gets good care regardless of their income.

He doesn’t want the impression left that someone who gets a subsidy to buy ACA coverage will get inferior care. “That’s been something, at least in our state, that we’re trying to work against. And the carriers are, as well,” Counihan says.

All three of the insurers on Connecticut’s exchange were asked to comment. Two declined. One agreed. Ken Lalime is the CEO of Healthy CT — an insurance co-op. He says insurers face a real challenge figuring out how to pay doctors enough but also keepÌýconsumer premiums low.

“Every time you increase payments to providers, you have to offset that with increased reimbursements from the consumer,” says Lalime. “So there’s this balance between how much do you want to cost to provide that service and how much you can pass along in your premiums rates. It’s a balancing act.”

Healthy CT may have missed the balanceÌý– just 3 percent of the exchange’sÌýconsumers bought the co-op’s insurance in 2014. Lalime says he also thinks low reimbursement rates are forcing some doctors to decide against accepting insurance under the Affordable Care Act.

Dr. Bob Russo is sure of it. He’s a radiologist and he’s also the president-elect of theÌý. He says that the low rates and administrative burdens that come along with the ACA could make it a financial loser.

“You get what you pay for,” Russo says. “If you can’t convinceÌý[doctors] that they’re not losing money doing their job, then it’s a problem. And they haven’t been able to convince people of that.”

He, like Counihan, worries about creating a tiered health care system. He says, think about Medicaid. Before a recent rise in rates, it paid doctors even less than Medicare, so many stopped accepting Medicaid patients.

“There’s no question that Medicaid, under its old rates, wasn’t working. So, have we just invented a new Medicaid that kind of slid the scale up a little more to make access a little more?” Russo says.

The experience of these doctors is a good reminder that the Affordable Care Act is more than a thought exercise in health care. It’s happening. And here’s another reminder: open enrollment for 2015 begins inÌý.

This <a target="_blank" href="/health-industry/a-doctors-perspective-on-obamacare/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

There’s one week left to get health insurance through the Affordable Care Act marketplaces, and states have gone to great lengths to enroll as many people up as possible. In Connecticut, the exchange has opened two retail storefronts where people can walk in and sign up.

“So, it’s just about 10 o’clock when we open up, and we’re just starting to see lines forming for people coming in as soon as we open,” he says.

Access Health CT opened the first retail storefront for a state exchange in New Britain, Conn., in November (Photo by Jeff Cohen/WNPR).

That’s become normal, he says, as the March 31 deadline for enrolling in Obamacare approaches. With just days to go, Connecticut’s exchange, , has done a than most states at enrolling people who are eligible. Strategies such as opening a retail store like this one may have played a role in that.

A few dozen people have come to check out their health insurance options. Debra White, 63, pays $300 a month to cover herself and her husband. That’s about a quarter of her monthly income. She can manage. But it’s not easy.

“I do have insurance, but I’m coming to see if I can lower the payment because I’m on a fixed income,” she explains.

Many say what drew them in was the idea of signing up for insurance in person — not on the phone, not on the computer, nor the smartphone.

“It makes it easier for me to converse with another person,” White says. “When I’m on the computer and everything, it’s confusing. Frustrating. Especially this time. I had a stroke, so at this time in my life it’s a little difficult.”

White is here with her grandson, Robert Taylor, 21. He works retail part time, and he goes to community college. He doesn’t have insurance at all and he’s here to get it.

“I’m healthy and I really don’t make too many trips to the doctors,” he says. “It’s just, when I do, I’d like to have a different way of paying for it other than coming out of my pocket.”

Michelle Perez is next in line for someone who speaks Spanish. She says she’s here to figure out if the new health insurance law can help her save some money. She’s holding a medical bill for a recent doctor’s visit. She’s diabetic and unemployed. And she’s here so someone can explain her options to her.

Also waiting for a broker is DeLisa Tolson. She lost her insurance when she got divorced three years ago. Since then, she’s gone to the emergency room and to mobile health vans for care.

“Even though they did a lot for me on the medical van, there were just some things they just couldn’t do,” she says. “And so, as far as mammograms and Pap smears, and being over 40, I decided it was time that I came down here and got Access Health.”

That was three weeks ago. Starting April 1, she’ll pay $86 a month for her insurance. That’s a lot better than the roughly $240 a month she had priced before the exchange plans were available.

Today she’s back, bringing a friend in to enroll.

“I came home and I explained to … all of my friends how easy it was and how comfortable it was,” Tolson says. “It didn’t take long at all, either. I was in-and-out within like 45 minutes to an hour. I felt very welcome. It was a very warm environment. It was nice.”

The state’s health care exchange says that Tolson is one of 10,000 people to have walked into one of its two retail stores — and that she’s one of 5,000 to have actually enrolled.

This story is part of a reporting partnership that includes , and Kaiser Health News.

This <a target="_blank" href="/insurance/connecticut-retail-store-rush-for-insurance/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

He’s the associate dean of admissions choosing the first class of a brand new medical school, the Frank H. Netter MD School of Medicine at Quinnipiac University in Connecticut. It’s a school with a very specific mission: minting new doctors who want to go into primary care practice.

“We have over 1,600 applicants, and we will interview 400 applicants for 60 spots,” Ellison says.

Under the Affordable Care Act, millions more people with insurance may be headed to the doctor’s office.ÌýThat means the medical system will need more doctors, nurses, physician assistants and other healthcare workers to meet the demand.Ìý Quinnipiac is spending $100 million on the new school, and it is one of about a dozen new medical schools on the horizon.Ìý A few of these new schools will also be focused on primary care.

The Netter School’s new dean, Bruce Koeppen, runs through the many reasons why new physicians don’t choose primary care: They don’t make as much money as specialists; they have to know about everything from the common cold to severe depression; and primary care physicians don’t always get the respect that specialists do.

To tackle these challenges, Koeppen says it’s important to admit the right students to the program. He cites demographic data that show who is more likely to choose general medicine.

“Turns out that women are more likely to go into primary care than men. Individuals who are coming to medicine as a second career are more likely to go into primary care,” Koeppen says.ÌýÌýÌý

David, a 35-year-old pharmacist who has applied for the fall semester, fits into that second category.Ìý(He asked that we not use his last name, because his employer doesn’t know he’s thinking of a career change.)

In his interview with Ellison, David described wanting to have a greater impact on patients’ lives, such as calming a child who is anxious during an exam or bringing a patient’s heart rhythm back in an emergency. “These moments weren’t available to me within the context of pharmacy practice,” David said.

In addition to career changers like David, Koeppen says students who are first in their families to go to college and students who’ve come from medically underserved areas are more likely to pursue primary care.

Henry Sondheimer of the Association of American Medical Colleges says that it’s good to be clear with your applicants on the front end.

“To the extent that you clarify your mission to your students who apply and, most importantly, when they interview, so they get to see what you’re doing and what you’re looking for, then you will find the students who will fit your mission,” Sondheimer says.Ìý“This is not for show.Ìý I think this is a very important, and very serious, effort by these schools.”

The question is, can it work?

Kevin Dorsey says it can and it does.Ìý He’s the dean of the Southern Illinois University School of Medicine in Springfield, Ill. ÌýHis school started in the 1970s with a specific mission that still guides it – the school wants students who will stay in central and southern Illinois when they graduate, because that part of the state needs doctors.

“I think we take, through a holistic admissions process, people that we think would be a good fit for this region,” Dorsey says. “They are of and from the region, they know the values of the area, we train them here, and they gravitate back.”Ìý

Southern Illinois designed a curriculum that gives prospective doctors hands-on, local experience.

“These students are farmed out back to local communities to work with a family medicine physician in that community, and so they eat, drink and sleep family medicine for about a month,” Dorsey says.

That’s a strategy that Quinnipiac also aims to try – in part by sending its students out regularly to spend a day with primary care doctors.ÌýAnd Koeppen says he hopes that strategy works, because he’s got an ambitious goal.ÌýNationally, about a third of graduating doctors go into primary care and stay there; Quinnipiac’s goal is for 50 percent of its graduates to stay in primary care.

This story is part of a collaboration that includes , and Kaiser Health News.

This <a target="_blank" href="/health-industry/quinnipiac-medical-school-primary-care/">article</a&gt; first appeared on <a target="_blank" href="">Â鶹ŮÓÅ Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">