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 »
TRUMP CONTINUES TO LAWYER UP
Kasowitz Out, John Dowd In
1 days ago
THE LATEST

As the Russia investigation heats up, "the role of Marc E. Kasowitz, the president’s longtime New York lawyer, will be significantly reduced. Mr. Trump liked Mr. Kasowitz’s blunt, aggressive style, but he was not a natural fit in the delicate, politically charged criminal investigation. The veteran Washington defense lawyer John Dowd will take the lead in representing Mr. Trump for the Russia inquiry."

Source:
ALSO INQUIRES ABOUT PARDON POWER
Trump Looking to Discredit Mueller
1 days ago
THE LATEST

President Trump's attorneys are "actively compiling a list of Mueller’s alleged potential conflicts of interest, which they say could serve as a way to stymie his work." They plan to argued that Mueller is going outside the scope of his investigation, in inquiring into Trump's finances. They're also playing small ball, highlighting "donations to Democrats by some of" Mueller's team, and "an allegation that Mueller and Trump National Golf Club in Northern Virginia had a dispute over membership fees when Mueller resigned as a member in 2011." Trump is said to be incensed that Mueller may see his tax returns, and has been asking about his power to pardon his family members.

Source:
INCLUDES NY PROBE INTO MANAFORT
Why Yes, Mueller Is Looking into Trump Businesses
2 days ago
THE LATEST

In addition to ties between Russia and the Trump campaign, Robert Mueller's team is also "examining a broad range of transactions involving Trump’s businesses as well as those of his associates, according to a person familiar with the probe. FBI investigators and others are looking at Russian purchases of apartments in Trump buildings, Trump’s involvement in a controversial SoHo development in New York with Russian associates, the 2013 Miss Universe pageant in Moscow, and Trump’s sale of a Florida mansion to a Russian oligarch in 2008, the person said. The investigation also has absorbed a money-laundering probe begun by federal prosecutors in New York into Trump’s former campaign chairman Paul Manafort."

Source:
Mueller Expands Probe to Trump Business Transactions
2 days ago
THE DETAILS

Special Counsel Robert Mueller's team is "is examining a broad range of transactions involving Trump’s businesses as well as those of his associates", including "Russian purchases of apartments in Trump buildings, Trump’s involvement in a controversial SoHo development with Russian associates, the 2013 Miss Universe pageant in Moscow and Trump’s sale of a Florida mansion to a Russian oligarch in 2008."

Source:
ANALYSIS FROM CBO
32 Million More Uninsured by 2026 if Obamacare Repealed
2 days ago
THE LATEST

"A Senate bill to gut Obamacare would increase the number of uninsured people by 32 million and double premiums on Obamacare's exchanges by 2026, according to an analysis from the nonpartisan Congressional Budget Office. The analysis is of a bill that passed Congress in 2015 that would repeal Obamacare's taxes and some of the mandates. Republicans intend to leave Obamacare in place for two years while a replacement is crafted and implemented."

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login