By Jennifer Popik, J.D., Legislative Counsel, NRLC’s Powell Center for Medical Ethics
Starting Tuesday, October 1, people around the country will begin enrolling in “exchanges” mandated by the Obama Health Care Law, choosing their health insurance for 2014. When they do so, however, many will find 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.
A New York Times article titled, “Lower Health Insurance Premiums to Come at Cost of Fewer Choices” explains
“When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low-and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.”
In addition to having access to fewer doctors and hospitals, the best medical centers are going to be excluded from many of the exchange plans. The same article [http://mobile.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html] notes
“In a new study, the Health Research Institute of PricewaterhouseCoopers, the consulting company, says that ‘insurers passed over major medical centers’ when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, among other states. ‘Doing so enables health plans to offer lower premiums,’ the study said. ‘But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.’”
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 competing 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.
It is important to continue to talk about the many dangers of the Obama Health Care law, particularly as they begin to roll out. With the new exchanges going into effect next week, and while the law remains deeply unpopular, it is important to warn others about the dangers these health care exchanges pose 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