ACA Insurance Exchanges Launch Amid Coverage Questions

  Workers Trained To Help Ease Transition To Affordable Care Act Insurance Marketplaces By: Joe Raedle Getty Images News Workers Trained To Help Ease Transition To Affordable Care Act Insurance Marketplaces. By: Joe Raedle/Getty Images  
National Journal
Clara Ritger
Add to Briefcase
See more stories about...
Clara Ritger
Sept. 30, 2013, 5 p.m.

Lead­ing up to Tues­day’s open­ing of the Af­ford­able Care Act health in­sur­ance ex­changes, much of the polit­ic­al pun­ditry fo­cused on wheth­er the cus­tom­ers would come.

Now that the ex­changes are open for busi­ness, the next ques­tion is wheth­er un­in­sured Amer­ic­ans will be sat­is­fied with what they find when they get there.

“I don’t think we can sit here today and say for cer­tain wheth­er they will ul­ti­mately have the care they need,” said Ceci Con­nolly, man­aging dir­ect­or of Price­wa­ter­house­Coopers’ Health Re­search In­sti­tute. “In our in­ter­views with pro­viders, it was a big con­cern.”

Price­wa­ter­house­Coopers last month re­leased its find­ings that in or­der to lower premi­ums, in­sur­ance com­pan­ies are lim­it­ing the num­ber of hos­pit­als and phys­i­cians avail­able to con­sumers in ACA ex­change plans.

“In­surers passed over ma­jor med­ic­al cen­ters in Chica­go, In­di­ana, Ken­tucky, Los Angeles, Ten­ness­ee, and else­where in an ef­fort to tamp down hos­pit­al and med­ic­al costs,” the re­port 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.”

Some­times, however, a nar­row net­work in­cludes a pro­vider such as the Mayo Clin­ic, which of­fers a full range of ser­vices, Con­nolly said.

“Much is go­ing to de­pend on the in­di­vidu­al and what their health status and needs are,” she said.

It is un­clear wheth­er pa­tients will be will­ing to make the trade-off of hav­ing few­er choices for a lower price tag. Gary Co­hen, dir­ect­or of the Cen­ter for Con­sumer In­form­a­tion and In­sur­ance Over­sight at the Cen­ters for Medi­care and Medi­caid Ser­vices, said lim­it­ing op­tions to drive down costs isn’t unique to Obama­care.

“The use of nar­row net­works is something that people have been talk­ing about for a long time as a way to keep health care costs down,” said Co­hen, who is lead­ing the im­ple­ment­a­tion of the ex­changes.

But Chris Jac­obs, seni­or health policy ana­lyst at Her­it­age Found­a­tion — the con­ser­vat­ive think tank as­so­ci­ated with Her­it­age Ac­tion’s cam­paign to de­fund Obama­care — said pa­tients have more to worry about than wheth­er they can keep their doc­tor.

“Are there even enough doc­tors in the net­work?” Jac­obs said. “If they get swarmed with people, are they go­ing to be able to take care of them?”

One of the reas­ons the in­dustry has lim­ited the net­works, Con­nolly said, is in re­sponse to pres­sure to keep prices on the ex­change at­tract­ive.

“This is a very price-sens­it­ive pop­u­la­tion that is lower in in­come,” she said.

Ac­cord­ing to the Price­wa­ter­house­Coopers study, 94 per­cent of in­surers be­lieve premi­um prices will mat­ter most to the people weigh­ing in­sur­ance cov­er­age on an ex­change.

It’s why some in­surers have op­ted out of some mar­ket­places al­to­geth­er.

One-third of health in­surers don’t plan to par­ti­cip­ate in the ex­changes, or haven’t yet de­cided, ac­cord­ing to the PwC study, cit­ing con­cerns about prof­it­ab­il­ity, un­der­stand­ing the be­ha­vi­or of newly eli­gible cus­tom­ers, and an­ti­cip­ated high use of ser­vices among those who enter the ex­changes.

In some mar­kets, this re­luct­ance has res­ul­ted in a loss of com­pet­i­tion. Ac­cord­ing to the Health and Hu­man Ser­vices De­part­ment, 5 per­cent of people — in­clud­ing those in West Vir­gin­ia and New Hamp­shire — will be shop­ping for ex­change plans offered by only one in­sur­ance com­pany.

What We're Following See More »
AFRAID HE’S TAKING SUPPORT FROM CLINTON
Democrats Taking Aim at Gary Johnson
0 minutes ago
WHY WE CARE

"Democrats panicked by third-party candidates drawing support away from Hillary Clinton are ramping up their attacks against Gary Johnson and warning that a vote for a third party is a vote for Donald Trump. Liberal groups are passing around embarrassing videos of Johnson and running ads against him warning about his positions on issues like climate change that are important to young voters and independents."

Source:
RUSSIA DENIES
Dutch Investigators: MH17 Was Downed by Russian Launcher
2 minutes ago
THE LATEST

Russo-Western relations are getting thornier all the time. "Dutch-led criminal investigators said Wednesday they have solid evidence that a Malaysian jet was shot down by a Buk missile moved into eastern Ukraine from Russia. Wilbert Paulissen, head of the Central Crime Investigation department of the Dutch National Police, said communications intercepts showed that pro-Moscow rebels had called for deployment of the mobile surface-to-air weapon, and reported its arrival in rebel-controlled areas of eastern Ukraine." Russia, of course, is denying culpability.

Source:
FIRST DEMOCRAT ENDORSEMENT EVER
Arizona Republic Endorses Clinton
6 minutes ago
WHY WE CARE

In its roughly 125-year history, the Arizona Republic has never endorsed a Democratic candidate for president. Until now. "The 2016 Republican candidate is not conservative and he is not qualified," the editors write, as they throw their support to Hillary Clinton.

Source:
TO BE INCLUDED IN SEPARATE BILL
Deal on Flint Aid Likely to Avert Shutdown
10 minutes ago
WHY WE CARE

Speaker of the House Paul Ryan and House Minority Leader Nancy Pelosi have reached a deal which is likely to avert a government shutdown. The biggest impediment had been the GOP's refusal to include funding for Flint water system reconstruction in the continuing resolution, and this solution provides an alternative measure likely to appease both sides. The funding for Flint will be included in the Water Resources and Development Act as an amendment to the version passed by the House of Representatives, one which will be passed in the senate. It now appears likely that Congress will in fact be able to keep the government open.

Source:
GOP REFUSED VOTE ON FCC COMMISIONER
Reid Blocks Tech Bill Over “Broken Promise”
16 hours ago
THE DETAILS

Monday night's debate may have inspired some in Congress, as Senate Minority Leader has decided to take a stand of his own. Reid is declining to allow a vote on a "bipartisan bill that would bolster U.S. spectrum availability and the deployment of wireless broadband." Why? Because of a "broken promise" made a year ago by Republicans, who have refused to vote on confirmation for a Democratic commissioner on the Federal Communications Commission to a second term. Harry Reid then took it a step further, invoking another confirmation vote still outstanding, that of Supreme Court nominee Merrick Garland.

Source:
×