Limited Access to Top Health Care Providers in California Obamacare Exchanges

 

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

ObamacareconfusionhdlCalifornians are finding themselves paying large amounts of cash or being turned away when they seek out many top health care specialists and hospitals, according to a Los Angeles Times article.

In a piece entitled, “Confusion over doctor lists is costly for Obamacare enrollees in state,” reporter Chad Terhune noted

Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation.

. . .

Nationwide, about half of all exchange plans feature narrow networks, according to consulting firm McKinsey & Co., which has closely tracked the new insurance market. Those narrow network plans cost up to 17% less on average than plans with broad networks.

In forming tighter networks, insurers tried to persuade doctors and hospitals to accept less money in exchange for a higher volume of Obamacare patients.

Terhune quoted Mark Morgan, president of Anthem Blue Cross, a unit of industry giant WellPoint Inc., who said, “These narrow networks are making a huge difference in terms of affordability,” adding, “We found in convincing numbers that people value price above all else.”

Of course, there are those who simply cannot afford adequate health insurance plans. However, to the extent those with some discretion in how they spend their money choose rock-bottom priced insurance, they are foolishly risking the lives of their family members. Children or spouses who die for want of adequate medical care will not be able to enjoy vacations, eating out, or other luxuries for which money “saved” by picking insurance solely on price is intended.

It seems more likely, however, that the real culprit is the Obamacare provision under which exchange bureaucrats must exclude insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders.

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.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must 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 means that insurers who hope to be able to gain customers within the exchanges have a strong disincentive to offer any adequately funded plans that do not drastically limit access to care. So even if you contact insurers directly, outside the exchange, you are likely to find it hard or impossible to find an adequate individual plan. (See documentation at www.nrlc.org/medethics/healthcarerationing.)

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.

Critical access to top health care providers is already being severely restricted in the individual health insurance plans on the Obamacare exchanges and there is reason to believe that when the exchanges are expanded to employees of all businesses, many employers will end their present coverage and force their workers into the constricted exchange plans. While Obamacare continues to be implemented in 2014, it is important to continue to educate friends and neighbors about the dangers the law poses in restricting what Americans can spend to save their own lives and the lives of their families.

You can follow up-to-date reports here: powellcenterformedicalethics.blogspot.com

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