Health system struggles to keep up with demand

After a controversial start, we survived the first round of the Affordable Care Act's health insurance open enrollment in 2013. Now we are bracing for round two, set to begin on Saturday.

The 2010 law helps to create plans with preventive care at the core, reducing long-term costs and improving health outcomes. However, can the medical community in Suffolk County -- which has fewer options than Nassau County -- meet the demands of beneficiaries?

In health care, as in other enterprises, supply needs to meet demand for the market to balance. While noble in its cause to serve the health needs of the community, the health insurance exchange is dumping new demand on a stressed medical market. The number of physicians available to meet that demand is shrinking, and hospital-acquired practices may not be an option if they are not accepting your health plan.

Here are ways to chart the problem.

The North Shore-Long Island Jewish Health System, for example, created its own insurance plan and is working with others, but Stony Brook University Hospital participates in only one of the eight local insurance plans offered on the state health exchange. Stony Brook contracted with Health Republic Insurance of New York, which runs on the MagnaCare provider network, but represents only 21 percent of Suffolk beneficiaries.

Smaller Suffolk hospitals are accepting other exchange plans, but the facilities may not have the treatment scope of Stony Brook, the county's only public hospital.

According to a report by the New York State of Health, the health exchange marketplace, nearly 1 million people signed up for coverage in last year's open enrollment. Sixteen percent live on Long Island, where private plan enrollees easily exceeded the number of those receiving coverage through Medicaid. From a public health perspective, the numbers are a success. Roughly 80 percent of people who purchased plans on the exchange had been uninsured, so preventive visits may uncover greater health care needs.

From a business perspective, physicians could view new customers as a way to grow practices. Yet, with mounting operating costs and shallower reimbursement schedules, many practitioners are opting to take early retirement or sell their practices to hospital networks.

A 2014 survey by the American Medical Group Association cites "retirement" as the reason 18 percent of physicians closed shop, a 50 percent jump from last year. With a flood of new insurance-card carriers in the market, this could spell trouble.

And the American Medical Association concluded in 2013 that only 53.2 percent of physicians owned their practices as of 2012, an 8-point drop since its last report in 2008.

In June, the Healthcare Association of New York, which represents hospitals and health systems, released a statewide survey on the doctor shortage. It said 63 percent of respondents couldn't meet the primary care needs of their communities. And while medical schools nationwide have increased their acceptances, the number of primary care residency slots at hospitals has not grown at the same rate. This requires overhauling the Medicare program, the funding source for graduate medical education, and that's unlikely to happen soon.

Who can blame physicians for choosing a more lucrative specialty or settling elsewhere? Long Island is known for its high living costs. Doctors Across New York, a statewide program, supports graduates pursuing primary care specialties through physician recruitment and retention awards, but this is not enough.

As we head into the second open enrollment, customers must weigh the costs and benefits of available plans. Several resources can help, including online health insurance information and your local library. While the solutions to the problem could take years to work out, your health can't wait.