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Conservative commentator Ann Coulter is not known for mincing words, but a recent column prompted many PolitiFact readers to contact us, seeking a fact-check.
In the Oct. 9, 2013, column -- titled, "Democrats to America: We Own the Government!" -- Coulter pummels Democrats over provisions of President Barack Obama’s health care law.
We were most intrigued by one claim, since we hadn’t heard it before -- that "no doctors who went to an American medical school will be accepting Obamacare."
We tried to ask Coulter through her speaker’s bureau if she could provide any evidence for this, but we did not receive a reply. We are sure the claim wasn't intended as a joke, because it's included in a bullet-point list of straightforward criticisms of the law.
So let’s start by looking at the claim literally. Is there any provision of the Affordable Care Act that would prevent U.S.-trained doctors from accepting "Obamacare" patients -- that is, patients who secure insurance through the marketplaces that are a centerpiece of the law?
We feel comfortable, both from talking to experts and from our years of reporting on the law, that there is no such provision. If there were, it would probably be ripe for challenge on constitutional grounds.
In fact, when we asked experts for their reaction to this claim, their responses included words such as "outrageous," "ridiculous" and "ludicrous."
"Of course there's nothing in the law that would bar any doctor from seeing any patient," said Katherine Baicker, a health economist at the Harvard School of Public Health.
So, no dice on the literal reading of her claim.
Still, we wondered whether there was some other tiny, buried grain of truth in what Coulter claimed. Is the idea that American-trained doctors will be pickier about accepting insurance?
There is some evidence that medical practices are wary about taking patients from plans sold on the marketplace. In September, the Medical Group Management Association -- a trade group for medical-practice executives -- surveyed 1,000 physician groups that collectively employ 47,500 doctors.
The survey asked, among other things, "Does your practice plan to participate with any new health insurance products sold on an ACA exchange?" Only 29 percent of respondents gave a definitive "yes." That rate is twice as high as the share that that said "no" (14 percent) but less than those that were still weighing their options (40 percent).
The top reasons? A fear of bureaucratic regulations, low reimbursement rates and the need to collect payment from patients with higher deductibles.
However, it’s important to remember that this study is not evidence that can be used to support Coulter’s specific claim, because it says nothing about foreign-trained doctors.
In fact, the closer you look at the issue of foreign-trained doctors, the less plausible Coulter’s claim becomes.
According to a 2010 study by the American Medical Association, about 26 percent of physicians in the United States were trained in other countries. This number includes both foreign-born doctors who trained overseas and Americans who received their medical education in other countries.
But tough licensing requirements for foreign-trained doctors -- requirements that won’t be changed by Obama’s law -- are keeping the number of foreign-trained physicians low. A key barrier is the need to obtain a residency in the United States, even if an applicant had practiced or had a residency overseas.
According to the New York Times, just 42 percent of foreign-trained immigrant physicians who applied for residencies through the leading matching service succeeded, compared to 94 percent of those who had trained in the United States.
With such high barriers to entry, it’s not credible that a flood of foreign-trained doctors will suddenly swoop in and, without the help of a single American-trained doctor, serve each one of the newly insured patients who bought policies on the new marketplaces.
"I haven't seen any study that would suggest that American-trained doctors would be disproportionately less likely to see the newly insured," Baicker said.
And even if there were such evidence, "disproportionate is a far cry from ‘none,’ " said Gail Wilensky, the former head of Medicare and Medicaid under President George H.W. Bush. "There is no limit to the nonsense that some are saying. This borders on the absurd."
Coulter said that "no doctors who went to an American medical school will be accepting Obamacare." Nothing in the law bars American-trained physicians from treating newly insured people under Obamacare. It’s a ridiculous claim -- one with a whiff of xenophobia -- that merits a Pants on Fire.
Ann Coulter, "Democrats to America: We Own the Government!" Oct 9, 2013
Medical Group Management Association, "ACA Insurance Exchange Implementation, Sept. 2013"
American Medical Association, "International Medical Graduates in American Medicine: Contemporary challenges and opportunities," January 2010
New York Times, "Path to United States Practice Is Long Slog to Foreign Doctors," Aug. 11, 2013
Email interview with Gail Wilensky, former head of Medicare and Medicaid under President George H.W. Bush, Oct. 16, 2013
Email interview with Robert Zirkelbach, vice president of strategic communications at America's Health Insurance Plans, Oct. 16, 2013
Email interview with Brenda L. Craine, director of American Medical Association media and editorial, Oct. 16, 2013
Email interview with Austin Frakt, Boston University health economist, Oct. 16, 2013
Email interview with Aaron E. Carroll, professor of pediatrics and assistant dean for research mentoring at Indiana University School of Medicine, Oct. 16, 2013
Email interview with Katherine Baicker, health economist at the Harvard School of Public Health, Oct. 16, 2013
Email interview with Fitzhugh Mullan, professor of medicine and health policy at George Washington University, Oct. 16, 2013
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