Only three in ten enrollees in Obamacare’s exchanges report being satisfied with their health coverage, according to a new poll from the Deloitte Center for Health Solutions.
Among the primary reasons for these poor numbers? Many exchange policies limit patients’ choices of doctors and hospitals in order to keep premiums down in the face of Obamacare’s intrusive regulations and costly mandates.
And with exchange policies poised to grow even more expensive in the coming years, those provider networks will only grow narrower. Patients may find themselves with coverage but without access to care — unless they’re willing to pay the doctor or hospital of their choice vast sums out of pocket.
So much for the “Affordable Care” Act.
According to the Robert Wood Johnson Foundation, nearly one-third of exchange plans have “small networks” — meaning that they include at most 25 percent of the doctors in the area. Another 11 percent of insurance policies had “extra small networks,” which include fewer than 10 percent of area doctors.
The Foundation reported that enrollees in one plan in Georgia could only see three percent of the doctors within a 10-mile area if they wanted to stay in-network.
Those shopping on the exchanges have far fewer options for care than their counterparts in the rest of the market. According to a July report from Avalere, a consultancy, the average exchange enrollee has access to 32 percent fewer primary care doctors and 24 percent fewer hospitals than the average person covered by a conventional private insurance plan. Exchange enrollees who suffer from cancer or heart problems have 42 percent fewer oncologists and cardiologists from which to choose.
Obamacare is directly responsible for these narrow networks. Prior to its passage, 80 percent of the health plans sold in the individual market had broad hospital networks, according to the consulting firm McKinsey. Last year, just over half of exchange plans did. Almost one in five had what the consulting firm labeled “ultra narrow” networks — meaning that fewer than a third of the hospitals in the area were covered.
Even worse, Obamacare’s exchange plans — offered through a state exchange or the federally operated HealthCare.gov — are not clear about what they cover. So a patient may buy coverage — and only later find out that the doctor or hospital she wants to visit is off-limits. McKinsey concluded that 44 percent of people who enrolled in an exchange plan this year didn’t know what kind of provider network they had.
Perhaps these folks were just taking the president at his word — that “most people are going to be able to get better, comprehensive health care plans for the same price or even cheaper.” Most folks signing up probably assumed that “comprehensive” included their choice of doctors and hospitals.
The Wall Street Journal recently told the story of a 50-year-old construction worker who believed that promise — until he went to an emergency room (ER) in Tennessee with chest pain. Despite his exchange coverage, the worker faced a bill of almost $23,000 because the hospital he visited was out-of-network.
Even those who are careful about staying in-network can receive massive bills. The New York Times reported on one Texas family who learned that the hard way.They received a $937 bill because the physician who attended to their son in an in-network ER wasn’t actually in the network himself.
A Pennsylvania father was slapped with a bill of over $2,000 when his daughter was treated by out-of-network physicians at an in-network ER.
Such instances aren’t out of the ordinary for exchange enrollees. One investigation found that the three biggest insurers in Texas had no in-network ER doctors.
Insurers have turned to narrow networks largely because of Obamacare’s community rating rules, expensive benefit mandates, and bans on annual or lifetime limits have left them few other alternatives for controlling costs.
Narrow networks, the Robert Wood Johnson Foundation report noted, are “one of the only remaining pieces in the insurers’ cost-containment toolbox.”
Instead of rolling back the mandates that are causing this narrow network problem, the federal government response is piling on still more regulation. The Centers for Medicare and Medicaid Services say that they’ll closely analyze the “network adequacy” of 2016 exchange plans and push to expand networks that they deem inadequate.
Of course, expanding networks by fiat will just push premiums even higher. Already, many insurers are asking regulators to approve rate increases of up to 50 percent next year. They’ve specifically cited “enhanced network access standards” imposed by the Obama administration as justification for the hikes. As insurer Aetna Inc. put it, these standards “limit our ability to control the cost and quality of medical care.”
More regulations are not the answer. Policymakers should instead free the healthcare marketplace of costly, distorting, and ultimately harmful government intrusions and mandates at the state and federal level. Only market competition can deliver the lower health costs and higher care quality that patients are looking for.