November 21 2013

Next Broken ObamaCare Promise: Your Doctor

Patrice J. Lee

ObamaCare is the Trojan Horse that just keeps on taking from Americans.

We’ve reported extensively on the President’s broken promise that if “you like your health insurance, you can keep your insurance.” The President also said the same for doctors, boasting, “No matter how we reform health care, we will keep this promise: if you like your doctor, you will be able to keep your doctor. Period.” Spoiler alert: This is the next big disappointment awaiting many Americans.

Patients are now discovering that they face far fewer options for healthcare providers and hospitals under ObamaCare or employer-based policies.  To participate in the federal exchanges, insurers needed to find ways to hold down high costs and so they have narrowed the networks of doctors available to patients under their plans. It’s possible that your preferred doctor, hospital or medical facility will not take your ObamaCare plan. Good incentive to enroll right?

The New York Times reports:

The Obama administration made it a priority to keep down the cost of insurance on the exchanges, the online marketplaces that are central to the Affordable Care Act. But one way that insurers have been able to offer lower rates is by creating networks that are far smaller than what most Americans are accustomed to.

The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.

A number of the nation’s top hospitals — including the Mayo Clinic in Minnesota, Cedars-Sinai in Los Angeles, and children’s hospitals in Seattle, Houston and St. Louis — are cut out of most plans sold on the exchange.

In most cases, the decision was about the cost of care.

This decision is prompting backlash from some hospitals that have been kept out of their insurer’s network. Some such as New Hampshire’s Frisbie Memorial Hospital now seek legal redress against insurance companies.

Lost in all of this are patients who face a difficult choice of whether to continue to receive care from preferred family doctors and specialists or secure coverage through the federal exchanges where their options are narrower. One man talks about his experience:

In New Hampshire, consumers who purchase insurance through the exchange have only one choice of carrier — Anthem BlueCross BlueShield— because no other insurer applied to join the exchange ...

That’s forcing people such as Michael Justice, 63, a Web developer from Peterborough, N.H., to leave doctors they like. Justice has been treated by primary-care doctors, cardiologists, orthopedists and eye doctors affiliated with Monadnock Community Hospital in his town for 15 years, and his wife for 30 years. But starting in 2014, that medical center will no longer be in network for the Anthem plans sold in his state, whether he buys the insurance through the health exchange or on his own.

Justice said he and his wife could go with another insurer, which costs $1,600 a month for the couple outside the marketplace, and continue to see their providers. Or they could pay half that if they purchase through the exchange.

“We’re being forced to choose between one bad option and another bad option,” said Justice.

And to make matters worse, if you choose to go with ObamaCare, the federal marketplace does not have a central online provider directory, where you can find a new doctor. A ratings group expert explained in the Denver Post last week, “Unless an exchange has put up an all-provider directory, it's going to be a fair amount of work to go through and check each plan.”

We shouldn’t be too surprised. If the Administration still hasn’t set up a payment system yet, why would they set up a tool to help enrollees search for care providers?

So who deserves the blame? The President and the architects of ObamaCare of course. However, because the (Un)Affordable Care Act is now in full effect, the better question is what can be done to mitigate these problems. Unfortunately, the answer is not much. Delays in the personal and employer mandates do nothing to address the new requirements that insurance plans cover new services and conditions that had not been covered before, a driver of the higher costs for ObamaCare.

The White House and advocates are already demonizing insurers, but that argument only goes so far.

 

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