Exchange enrollees finding insurance plans that limit specialists and hospitals

By Jennifer Popik, JD,Robert Powell Center for Medical Ethics

Obamacare09As Americans engage in the increasingly frustrating process of attempting to enroll in health plans in new health care exchanges, many are finding their alternatives limited to cut-rate plans that allow them to see only narrow groups of health care providers that exclude the best specialists and health care centers.

Not only are many plans limiting access to the best doctors and hospitals, but there are many insurers who are not offering any plans at all in the states exchanges.

Meanwhile, an October 30, 2013, Washington Post story reported that hundreds of thousands are getting notices that their health insurance policies they now have will not be renewed. The Post’s Lena H. Sun and Sandhya Somashekhar quoted New Jersey’s Governor Chris Christie who told “CBS This Morning”

“The real problem is that people weren’t told the truth. You can remember, they were told that they would be able to keep their policies if they like them. Now you hear hundreds of thousands of people across the country being told they couldn’t.”

While administration apologists claim that “substandard” plans are being replaced by better ones, that is belied by the limitations of the plans now being made available.

In an October 21, 2013, piece entitled “Big insurers avoid many state health exchanges,” USA Today reporter Annika McGinnis reported:

“Some insurers pulled out of the exchanges required by the Affordable Care Act as the Oct. 1 launch approached. That leaves an uneven patchwork of providers — ranging from one insurer in New Hampshire and West Virginia to 16 in New York.”

Even more disturbing is the fact that remaining insurance providers are feeling forced under the provisions of the law to offer very limited options. McGinnis goes on to explain,

“In New Hampshire, the exchange has just Anthem Blue Cross and Blue Shield, which greatly reduces the number of hospital options, says State Sen. Andy Sanborn. Since more than 90% of doctors are affiliated with specific hospitals, the new plans will also exclude many doctors, he added. Plans don’t include the capital’s Concord Hospital, and the next-closest hospital uses Concord doctors, Sanborn said. So, he said, people will have to drive to a third hospital an hour away. They’ll even have to call an ambulance from a far-away hospital to pick them up, he said.”

This problem is not limited to New Hampshire. This past fall, the Health Research Institute of PricewaterhouseCoopers consulting company reported that insurers passed over major medical centers when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, as well as other states.

In an October 25, 2013 New York Post article headlined, “Elderly patients sick over losing doctors under ObamaCare,” Carl Campanile writes

“Elderly New Yorkers are in a panic after getting notices that insurance companies are booting their doctors from the Medicare Advantage program as a result of the shifting medical landscape under ObamaCare. That leaves patients with unenviable choices: keep the same insurance plan and find another doctor, pay out of pocket or look for another plan where their physician is a member. New York State Medical Society President Sam Unterricht is demanding a congressional probe after learning that one health carrier alone, UnitedHealthcare, is terminating contracts with up to 2,100 doctors serving 8,000 Medicare Advantage patients in the New York metro region.”

This problem will not end here.

While insurers are moving to make their plans less expensive at the cost of sacrificing access to doctors and specialists, there is the real possibility that plans that choose not to limit access will be forced to do so under the Federal Regulations governing the exchanges.

There are a set of restrictions written into the health law with the effect that consumers may only choose plans offered by insurers who do not allow their customers to spend what state bureaucrats deem an “excessive or unjustified” amount for their health insurance.

Under the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” Not only will the exchanges exclude policies from being offered in an exchange when government authorities do not agree with their premiums, but the exchanges will even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount.

This will create a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering adequately funded plans even outside of them. The result will be that even outside the exchanges consumers will find it difficult to obtain health insurance that offers adequate and unrationed health care.

Documentation for this can be found www.nrlc.org/uploads/medethics/LifeatRisk112012.pdf

When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.

With the new exchanges going into effect, it is important to continue to educate friends and neighbors about the dangers the law governing them poses in restricting what Americans can spend to save their own lives and the lives of their families.

Note: the abortion related provisions dealing with the state exchanges can be found here: www.nrlc.org/AHC/index.html

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