11/26/2013
Aaron CarrollFrom Kaiser Health News:
Officials in at least a half dozen states are pushing back against health plans in the new insurance markets that limit choice of doctors and hospitals in a bid to control medical costs.
The plans don’t start offering coverage until January but they’re facing regulatory action, possible legislation, and in at least one case involving a high-profile children’s hospital, litigation.
The pushback against “narrow” provider networks recalls the backlash against managed care and health maintenance organizations in the 1990s. Protests from consumers and hospitals eroded those attempts to restrain expenses by narrowing provider networks.
Now criticism of limited networks has risen as consumers realize that, despite President Barack Obama’s pledge that they could keep their doctors, their Affordable Care Act insurance may not include the physicians or hospitals they’ve been seeing.
I’m seriously amazed people are amazed by this. Narrow networks are not new. Networks are not new. I’ve never had a plan that didn’t differentiate between “in network” and “out of network”. I imagine the only plans that don’t have such networks are… government plans.
Has no one heard of an HMO? Seriously?
Do you know why such plans exist? Cause they’re cheaper:
Broader choice comes with a price. The ability to sell less-expensive plans with limited choices of doctors and hospitals helps contain medical inflation, health economists argue. Looser networks could. mean higher prices.
Is this really news?!?!?!
by David C on November 26th, 2013 at 11:50
There is a criticism on the networks on the Exchanges that seems valid to me. Finding information on the Exchanges about which providers are in which networks is basically impossible. You might be able to look at individual insurers’ websites to get this information, but it isn’t always easy.
To be fair, this is a problem with group insurance too. But given how important narrow networks are to the Exchanges, it seems a shame that people can’t readily determine if their PCP or favorite hospital is covered.
by Cardinal Fang on November 26th, 2013 at 14:55
This is a huge problem in California. Right now, it’s impossible to get an accurate list of which providers are on which insurance plan.
I don’t know for sure, but I get the impression that insurers are still negotiating with providers, and the final list of providers can’t be found because there is not yet a final list of providers.
by Jimbino on November 26th, 2013 at 12:15
I am a non-believer in insurance. As a result, I can choose to spend my healthcare dollars anywhere in the world, whether at a high-priced Amerikan clinic or at a bargain one in Mexico, Costa Rica, Thailand or Prague.
Since insurance returns less than 80 cents on the healthcare dollar, I also end up financially way ahead. In many cases, health care overseas costs less than a co-pay here.
Insurance is a religion that I won’t be sucked into.
by Sean Parnell on November 26th, 2013 at 22:27
Self-pay health care in the U.S. can cost less than a co-pay too: http://theselfpaypatient.com/2013/09/11/for-less-than-many-insurance-co-pays-this-doctor-in-austin-texas-will-see-you/
When it comes to primary care at least (and some specialty, hospital, and surgical care too) it’s not health care that’s expensive, it’s health insurance.
by Robert Aylward on November 26th, 2013 at 12:44
The other argument is that the insurer can negotiate a lower rate from providers by offering exclusivity to the provider. Any willing provider laws preclude that bargaining chip. How the anti-any willing provider provision in ACA affects all of this isn’t addressed.
by Jeremy N on November 26th, 2013 at 15:17
It is news because most of the public didn’t expect it. There are polls showing that people dislike Obamacare more than the ACA, for example. President Obama promised costs would go down, but he never said they’d go down by restricting your choices. As someone who follows this very closely, this may seem obvious to you, but to the majority of the public, they just hear soundbites. They don’t know the specifics behind the policy and the effects. That’s why it’s news.
by ezra abrams on November 26th, 2013 at 16:04
Googling healthcare cancellation 1980, I came across “recission” in CA and Texas – 10s of thousands of people who , *after* they got sick, had the policy canceled on the grounds that the initial application (perhaps 10 years ago) was defective in some way
doesn’t anyone remember this ?
by Brad F on November 26th, 2013 at 21:36
From Chris Jennings at the WH today:
“The concept is to funnel a larger volume of patients to fewer, quality-selected providers, sometimes in exchange for lower reimbursement rates.”
If you want high quality providers, who by definition provide higher value care (lower cost), do you pay them less for a greater volume of patients?
http://www.modernhealthcare.com/article/20131126/NEWS/311269951
by Sean Parnell on November 26th, 2013 at 22:40
Well, I’ve definitely heard of HMOs (worked on the campaign side for Congressman Greg Ganske for 4 years, who was one of the leading proponents of the Patients’ Bill of Rights). I think the ‘news’ in all of this is that the President and his political allies basically oversold this again, neglecting to mention that the policies that are affordable to most people through the exchange would closely resemble the HMOs of old.
I remember Ganske talking about how movie audiences would spontaneously burst into applause when Helen Hunt delivered a diatribe against HMOs and their executives in ‘As Good As It Gets,’ and how to him it was evidence of how people hated HMOs. I suspect he was on to something. The thing I kept reminding my lefty friends who wanted single payer, or something at least more closely resembling the ‘regulated utility’ model that I think fairly characterizes Obamacare, is that under such systems it’s going to be the politicians who are targets of those Helen Hunt-style diatribes (fairly or not in many cases). I’m not sure that’s progress.
by Sheldon Weisgrau on November 27th, 2013 at 10:43
Difficulty in determining which providers are in insurance networks is not a problem unique to plans sold in ACA marketplaces. It’s been a problem since insurance plans have included provider networks and it’s always a moving target, as providers come and go in networks. It’s worth noting that it’s considerably easier to do today than it was in the days before widespread internet access.
Alarm over limited networks is largely hyperbole. As Aaron notes, it’s not a new phenomenon and it’s a tool of cost containment. The question becomes – what’s the solution? And is a solution needed? I note that more transparency about networks likely requires more regulation, a solution that conservatives will dislike.
by Janice Michaud on December 1st, 2013 at 20:58
The alarm over narrowed networks, I will argue vehemently, not exaggerated. If anything what has been lost is underappreciated.
I am an insurance agent in CA and the task of replacing plans that have lost 30-40% of their networks is frightening.
It is one thing to have doctors or other specialists out of network, but to have hospitals or physician groups missing and then pay more… it is an outrage. At point of service, this will bring outrage. I don’t think most consumers understand what point of service will be like.
My clients buy insurance to protect thier assets and future earning power. They have always had access to nationwide specialized providers. This is essentially not having a stop-loss.
Janice
by Cardinal Fang on December 2nd, 2013 at 12:34
Janice, do you clients want to pay what it would cost to have those expensive hospitals in network, now that their plan has to include sick people too? Your clients are healthy– we know that because they were able to buy private individual insurance. Do they really want to pay for other people to get knee replacements and gall bladder operations and routine heart operations at Cedars Sinai instead of Nice Community Hospital?
Insurers can’t keep premiums low now by excluding expensive people, so they are trying to keep premiums lower by excluding expensive hospitals.
by Tyche on December 22nd, 2013 at 02:23
I actually enrolled in Obamacare, and when I re-checked which providers were offered, I discovered that most of them had been removed (from the time I first checked with the single insurance provider offering a policy in my area.) The nearest cardiologist is now 100 miles away and the nearest specialist in cancer is 75 miles away. The major hospital and affiliated cancer center in my town (and the only cancer treatment center nearby) is not in the network — nor is the main hospital 80 miles away, which handles complicated cancer cases, and is on the ONLY children’s hospital in the state, in the plan.
But the worst part came as such a surprise: I’ve never seen a policy that paid ZERO for out-of-network providers. I thought they all paid at least 50% or 75% of regular charges. So if I have a wreck and I’m admitted to the wrong hospital, then I have NO insurance — or after a heart attack, I must drive 90 miles to a doctor or pay the full price locally, out of pocket, and that payment wouldn’t even count towards the 6200 out of pocket limit? Should I get cancer, for each checkup or treatment, I must drive 75 miles?
Talk about junk insurance!! And for this: $635 a month for a bronze plan with $4000 deductible. (I’m 58, no pre-existing conditions though that doesn’t matter now.) I’m cancelling my enrollment since I have a medically underwritten private policy that’s $150/month for $8000 deductible, but it pays out-of-network provides 75% (United Healthcare.) I fear they will also tighten the network on me, but I’ll deal with that if it happens — meanwhile, I’ll keep the insurance that has 90% of the local providers instead of 1% of them.
by ezra abrams on December 22nd, 2013 at 11:20
respectfully,
1) as i understand the ACA, if you have a medical need, then you get out of network providers at no cost
2) politely, if you wish to live in a rural area, you can’t expect the same resources you get in a big city; you don’t disclose your location, but living in beautiful rurual WY has its ups and downs
but maybe I’m misunderstanding your condition