[lotsofpulp]

>Many foresee a two-tiered system developing, where the rich see physicians, and the poor see midlevels.

There already was a tiered system, with rich people being able to buy concierge medicine and getting preferred treatment based on who knows who on the hospital's board or if their name is on a wing of the hospital.

The change now is a more visible and more granular price segmentation.

[jac241]

There’s no price segmentation. You pay the same for a visit with a PA or NP as for one with a physician, so why see someone with less than a tenth the experience who may have gone to an online only school with 100% acceptance rate and shadowed for 500hrs of “clinical experience“ right out of nursing school?

[lotsofpulp]

It will happen via in network and out of network agreements.

Healthcare providers with greater proportion of NP/PA will be selling for cheaper, so MCO will sell access to only them in their lower price plans, and healthcare providers where you get to see doctors will be in higher price plans.

This already happens, especially with many healthcare providers not accepting lower reimbursed Medicaid patients.