States Look To Pass Laws To Broaden Obamacare Networks


One of the “unexpected” results of the “Affordable” Care Act’s notion of reducing health care costs has been a restriction of in-network providers. This is where quite a few folks found out that if they like their doctor, they can’t keep their doctor. Since most people who signed up through the Exchanges were people who previously had insurance and saw it cancelled, rather than those who did not have insurance, this is important. Also, quite a few hospitals, including the best hospital, have been left out of the networks. How is this working out?

(Bloomberg) Health insurers under pressure to keep premiums low are eliminating some hospitals from coverage in a cost-cutting strategy that threatens to freeze out centers that provide specialized care, limiting patient options. (snip)

The law puts pressure on premiums by requiring insurers to “broaden health benefits, restricting how much premiums can vary with age and adding a new health-insurance tax,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, or AHIP, a Washington-based trade group. Narrowing networks to those that accept lower payments in exchange for higher patient volume “is one way to help mitigate profit increase for consumers,” he said.

Insurers say one way to help lower costs is to select medical providers who deliver quality care at a low price. This week, the Health and Human Services Department said insurance plans may be required to include at least 30 percent of “essential community providers” in each county in 2015 from 20 percent this year. That means about 38 percent of current plans would need to broaden their networks, according to the McKinsey study.

So, HHS is going to blow out one of the main cost reduction methods caused by Obamacare and the rules passed by HHS. This could result in skyrocketing costs for the insurers and the insurers dropping out of the Exchanges.

Quite a bit of the article is about the Seattle Children’s Hospital, which is excluded from 5 of the 7 plans in Washington state. They are excluded because they are more expensive than other hospitals. The article forgets to note that they’re more expensive because they are very very good. Their “product” is top notch. Both a Camry and a Maserati are simply cars with four wheels, an engine, and a steering wheel, right? Why does one cost more than another? Exactly.

Many hospitals, doctors, and medical centers want to be in-Network (many don’t, especially doctors). But the Exchange plans have to save costs. In comes government, beyond the aforementioned HHS

(Fox News) Lawmakers in a Washington state Senate committee heard a proposal this week that would reportedly allow health insurance companies to keep offering insurance plans that don’t meet the new federal and state requirements. But they would only be offered to people who were enrolled in such plans as of Oct. 1, 2013.

Senate Bill 6464 also would let insurers from other states sell plans to Washingtonians without requiring the carriers to meet Washington state insurance regulations.

Both of those seem to violate federal law.

Meanwhile, in Mississippi, proposed legislation would bar insurers from cutting off most doctors and hospitals that agree to prices set by insurers. The bill also would prohibit insurers from charging higher copayments at certain doctors’ offices or hospitals, according to The Wall Street Journal.

Many other states are looking at similar legislation. What would this mean? Escalating costs. These will be funded by either the consumer or the pool of taxpayers. This would also mean reduced reimbursement rates to the medical facilities. And reduced care.

Yes, networks have always been restricted with insurance. And you do not always get to keep your doctor when switching. I’ve lost my dentist three times in 20 years because my company changed their dental insurance. Obamacare causes severe restrictions on networks both by the insurance companies and because medical facilities, primarily individual doctors/care professionals, want nothing to do with Ocare. So states and HHS will force the networks to grow. And we can all guess that this will cause Ocare costs to skyrocket.

Crossed at Pirate’s Cove. Follow me on Twitter @WilliamTeach.

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