In an article called “More Insured, but the Choices Are Narrowing” the NY Times, the Bible of the progressive movement finally realizes that people are being forced away from their doctors.
In the midst of all the turmoil in health care
these days, one thing is becoming clear: No matter what kind of health plan
consumers choose, they will find fewer doctors and hospitals in their network —
or pay much more for the privilege of going to any provider they want.These so-called narrow networks, featuring
limited groups of providers, have made a big entrance on the newly created
state insurance exchanges, where they are a common feature in many of the
plans. While the sizes of the networks vary considerably, many plans now
exclude at least some large hospitals or doctors’ groups. Smaller networks are
also becoming more common in health care coverage offered by employers and in
private Medicare Advantage plans.
Insurers, ranging from national behemoths like
WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully
embracing the idea, saying narrower networks are essential to controlling costs
and managing care. Major players contend they can avoid the uproar that
crippled a similar push in the 1990s.
The insurance companies have to cut back on the number of doctors in their networks to keep costs down. And its not just the doctors:
The majority of insurance plans being sold on the new healthcare
exchanges in New York, Texas, and California, for example, will not
offer patients’ access to Memorial Sloan Kettering in Manhattan or MD
Anderson Cancer Center in Houston, two top cancer centres, or
Cedars-Sinai in Los Angeles, one of the top research and teaching
hospitals in the country.
Experts say the move by insurers to limit consumers’ choices and
steer them away from hospitals that are considered too expensive, or
even “inefficient”, reflects the new competitive landscape in the
insurance industry since the passage of the Affordable Care Act, Barack
Obama’s 2010 healthcare law.
Then there are the stories where the networks published by the insurers contains many doctors who are not really in the network, which were reported as happening in NY and California.
Other complaints involve confusion over which providers are participating in which plans.
“The thing you’re buying is access to the provider network,” said Lynn Quincy, a policy expert at Consumers Union. “Right now it feels like you’re forced to guess.”
(…) Outside the exchanges, insurers are also
promoting smaller networks for employers as a way to reduce overall health care
costs, said Larry Boress, chief executive of the Midwest Business Group on
Health. “The larger the network is, the higher the cost,” he said.Employers remain concerned about the quality of
the networks, said Mr. Boress, and many are doing an analysis to see how
disruptive changing the network would be for their workers.Nonetheless, the bottom line is that more
employers are considering smaller networks. Many, like Walmart and General
Electric, have gone so far as to steer employees to specific hospitals for
certain expensive procedures like joint replacements.
After much debate, New York regulators decided last month not to require health plans to offer out-of-network benefits in 2015, despite pressure from patients and doctors.
New Hampshire regulators are also trying to weigh in on the decision by the state’s only insurer, WellPoint, to exclude some hospitals.
In Washington, Seattle Children’s Hospital is challenging state insurance regulators because some of the plans exclude it.
Smaller doctor and hospital networks were all predicted by conservative observers during the debate leading up to the passage of Obamacare. Sadly it took four years for the progressive media to catch up.
But as healthcare consumers realize they purchased a “pig in a poke” public opinion of the President’s signature health plan will continue to fall giving the GOP opportunities to make changes or, after the President leaves office in January 2017, totally repeal and replace with something better.