Plans On HIX Limit Choice of Doctors, Hospitals
By Dr. James Palermo // November 23, 2013
OBAMACARE AND THE PRESIDENT INCREASINGLY FALLING OUT OF FAVOR
ABOVE VIDEO: Fox News interviews Johah Goldberg of The National Review for his perspective on the promises made by the President and Obamacare proponents and the three primary issues that have come to light with the launch of Obamacare that challenge the veracity of those promises and credibility of those proponents, and have a profoundly adverse impact on the healthcare coverage for many Americans.
Stories in many of the major media outlets have featured reports that Americans who are shopping for health insurance on the Affordable Care Act health insurance exchange (HIX) marketplaces are, much to their chagrin, discovering that the available plans on the HIX restrict the choice of doctors and hospitals in order to keep premiums low and “affordable.”
SOME PHYSICIANS AND HOSPITALS BALK AT PARTICIPATION IN HIX PLANS
Plans that offer limited provider networks typically offer lower premiums because they have either excluded the most expensive providers or insurers have negotiated discounts with participating providers in exchange for routing them more volumes.
According to a front-page story in the Washington Post, there is now “a two-tier system” as “many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers.” The Post says this situation has been exacerbated by some “providers” that “have balked at being in exchange networks because they are unhappy with the reimbursement rates or are concerned that the exchanges could be dominated by sick people who won’t be able to pay their portion of the bills.”
As noted in an Associated Press story earlier this week, President Obama “promised people could keep their doctors,” which could make this “the next health overhaul issue.” American Medical Association president Dr. Ardis Dee Hoven is quoted as saying, “Although it may be too early to reach any definitive conclusions, we are monitoring the adequacy of the exchange networks and will be analyzing the impact of these restrictive strategies on patient access to care.”
HMOs REVISITED IN OBAMACARE HIX
What the American healthcare consumer is experiencing when they go to the Obamacare insurance exchanges is something that may well remind them of the late 80s and early 90s when the Health Maintenance Organization (HMO)/Managed Care concept was hailed as the healthcare cost containment Holy Grail.
Our fascination with HMOs was short-lived. As a rule, Americans have been reluctant to accept limitations on their health-care choices. In 2012, HMOs accounted for less than five percent of consumer plans sold through eHealth-Insurance.com and, according to a Kaiser Family Foundation survey, only 16 percent of workers with employer-sponsored health insurance were enrolled in HMOs.
Although limited provider panels are on the forefront of concern, other limits aimed to control costs, such as referrals from the primary care “gatekeeper” for patients to obtain referrals to see specialists or obtain preauthorization for costly diagnostic or therapeutic procedures are also included in many of the offerings on the HIX.
WEBSITE GLITCHES ASIDE, CRITICAL PLAN NETWORK INFORMATION NOT AVAILABLE ON LINE
Information related to participating physicians and other limitations are not routinely available on the HIX website. The Washington Examiner reports that consumers visiting healthcare.gov are not able “to learn whether their doctors participate in an Obamacare-approved health care plan because the website doesn’t include such information.”
Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters, explained to the Examiner: “Under the exchanges, the government did not require health plans to submit detailed network information. That’s why the networks aren’t listed on healthcare.gov. When you go to look in at the plan choices, you can’t see the provider networks.”
ACA RAPIDLY FALLING OUT OF FAVOR ACROSS ALL DEMOGRAPHICS
The fundamental goals of U.S. healthcare reform should be improving the patient experience of care to include assuring high quality and satisfaction, improving the health of populations through more affordable and accessible insurance coverage and preventive care, and reducing the per capita cost of health care.
The Obamacare implementation debacle that has evolved over the past seven weeks and the ramifications of the provisions in the law now that we are “learning what’s in it” have not instilled in Americans a great deal of confidence in the law and, based on his comments that have proved to be false about being able to keep health plans, has reflected very negatively on the President.
The ACA is rapidly falling out of favor with many, who pre-implementation were proponents of the law. A CBS News survey this week showed a startling drop in support for the ACA, with approval dropping to 31 percent, down 12 points since October. Also, according to the poll, the president’s approval rating slipped to 37 percent, from 46 percent just last month.
It’s early, but the law is staggering and whether or not these fundamental goals can actually be met through Obamacare remains to be seen.