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
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 »
STAFF PICKS
What the Current Crop of Candidates Could Learn from JFK
23 hours ago
WHY WE CARE

Much has been made of David Brooks’s recent New York Times column, in which confesses to missing already the civility and humanity of Barack Obama, compared to who might take his place. In NewYorker.com, Jeffrey Frank reminds us how critical such attributes are to foreign policy. “It’s hard to imagine Kennedy so casually referring to the leader of Russia as a gangster or a thug. For that matter, it’s hard to imagine any president comparing the Russian leader to Hitler [as] Hillary Clinton did at a private fund-raiser. … Kennedy, who always worried that miscalculation could lead to war, paid close attention to the language of diplomacy.”

Source:
STAFF PICKS
Maher Weighs in on Bernie, Trump and Palin
1 days ago
WHY WE CARE

“We haven’t seen a true leftist since FDR, so many millions are coming out of the woodwork to vote for Bernie Sanders; he is the Occupy movement now come to life in the political arena.” So says Bill Maher in his Hollywood Reporter cover story (more a stream-of-consciousness riff than an essay, actually). Conservative states may never vote for a socialist in the general election, but “this stuff has never been on the table, and these voters have never been activated.” Maher saves most of his bile for Donald Trump and Sarah Palin, writing that by nominating Palin as vice president “John McCain is the one who opened the Book of the Dead and let the monsters out.” And Trump is picking up where Palin left off.

Source:
×