Politico is up this morning with a story about the network selection in the Obamacare exchanges. Health networks have been experimenting with tightening their provider networks at least since the 90’s as a means of cost control. The biggest problem they have is consumers don’t like that much. Yes, the consumers are price sensitive, and this is as they should be. But, they also want to keep their doctors and be able to patronize their local hospital and imaging center and so forth.
“People have to recognize it’s a trade-off, and I’m not sure they do yet,” said Matt Eyles, an insurance expert at the Avalere Health consulting firm. “Broader access comes at a cost, and what’s the right balance between access and cost is an age-old question in health care.”
This is more than just a consumer-driven nightmare. It has political implications as well. The architects of PPACA mandated care should be in a “timely” manner, and that insurers should widen networks sufficiently so this could be done, but the act does not define “timely,” and implementation is left up the the States, each of whom still has much to say about who is allowed to sell insurance therein. There are now more than 70 bill pending or passed in the several State legislatures regarding network access. Further, with elections coming up, people are using the tighter networks against incumbent politicians fool enough to vote of Obamacare; notably Jean Shaheen in New Hampshire. Republicans are using the narrow networks as political ammunition, citing this as a broken promise from the President about keeping one’s doctor.
Advocates of the health care law, and of narrowed networks in general, are tending toward a “that’s how it has to work, deal with it” attitude. Predictably, they’re not finding this an easy sell. Nor are there any good choices: to keep the price down, you can’t keep your doctor. If you want access to your local medical people, the price goes up. Both tend to have an adverse effect on the public perception of Obamacare, a law which, despite the best wishes of Democrats, has never yet enjoyed majority approval.
Two other issues are also prominent: It’s not easy to tell which doctors are in what network. The feds are supposed to be working on this, but I suspect the States will work it out sooner. A simple rule requiring publication of all doctors within the network before you can sell a policy would work. Another problem is not all doctors are in network even within a covered hospital. Thus, an insurance company approved surgery in a covered hospital might still result in thousands of dollars of bills for anesthesia or lab work. There really isn’t any cure for that but to include all associated doctors in a covered hospital.
Another issue springing to mind is the need for Republicans to do everything in their power to defund the risk corridors. I got no love for the insurance companies who helped the Democrats foist this monstrosity on the People. If they lose a few billion dollars– preferably go out of business over it– I say well deserved. Let the price the insurance companies charge reflect the real costs– and let Obamacare bear the brunt of that disapproval.
Joel Ario, former director of the HHS Office of Health Insurance Exchanges and a former insurance commissioner in Pennsylvania and Oregon, said “it would be a real mistake” for the federal government to weigh in with a single standard for all plans.
Ain’t that the borking truth? This is quintessentially a consumer decision. If there’s a better reason why the federal government shouldn’t be involved in health care at all in any manner, I don’t know what it would be.