Obamacare Limits Patient Choice and Coverage

President Obama and Washington Democrats first sold their health care law as the best way to reduce the cost of care. When it became clear that many people would see huge price increases for insurance, the Administration changed its sales pitch. Prices might not be lower, but the coverage would be better. It turns out, the revised story is no more true than the original one.

In an effort to keep premium costs down and increase consumer plan options in the government exchanges, insurers negotiated with hospitals and doctors to accept deep discounts from their customary commercial plan rates. The provider is paid less because patients will have fewer health provider network choices – effectively increasing the provider’s patient volume.

Industry experts believe consumers will buy exchange plans with very restrictive provider networks if the premium remains low. As the Wall Street Journal noted, “Plans with smaller choices of health-care providers are a big focus for insurers, partly because many other aspects of exchange plans, including benefits and out-of-pocket charges that consumers pay, are largely prescribed by the law, giving them few levers to push to reduce premiums.”

The New York Times warns of one glaring problem with this model: “Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers … under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.” The article cites a study by the Health Research Institute of PricewaterhouseCoopers that found in several states, “insurers passed over major medical centers” when choosing providers. That meant lower premiums than they would otherwise have charged, but higher out-of-pocket expenses – especially for patients with complicated medical problems seeking treatment at hospitals excluded from their health plan network or patients already receiving treatment at a facility suddenly dropped from their health plan network.

President Obama pledged: “If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” The truth is that President’s health care law restricts people’s ability to choose the provider or hospital that meets their needs.

The Congressional Budget Office estimates seven million Americans will lose the employer-provided coverage they have today. These people, and their families, will be forced to enter the health law’s exchanges in order to purchase a government-mandated and approved insurance plan. Americans may quickly discover that the President’s health care law caused them to lose their employer-sponsored health insurance and replaced it with a government exchange plan that limits the health care provider choices they have today.

Health Care Headlines

Reuters: “U.S. delays online enrollment for small-business healthcare exchanges” The Obama Administration will delay online Obamacare enrollment for small businesses in federally operated healthcare exchanges until November 1, one month later than planned. The Administration said small businesses would still be able to enroll beginning October 1 through paper applications, in-person meetings, or over the phone to a federal call center.

Politico: “Exchanges may have high out-of-pocket costs” Consumers may have to dig a little deeper into their wallets to pay for health care in the Obamacare insurance exchanges, according to a new analysis by Avalere Health. The study of six states suggests that consumers could face steep cost-sharing requirements – like co-payments, co-insurance and deductibles – layered on top of their monthly premiums.

New York Times: “Lower Health Premiums to Come at Cost of Fewer Choices” Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.

Los Angeles Times: “Insurers limiting doctors, hospitals in health insurance market” The doctor can’t see you now. Consumers may hear that a lot more often after getting health insurance under President Obama's Affordable Care Act. To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state’s new health insurance market opening Oct. 1.

Wall Street Journal: “Prices Set for New Health-Care Exchanges” U.S. officials for the first time disclosed insurance prices that will be offered through new federally run health-care exchanges, showing that young, healthy buyers likely will pay more than they do currently while older, sicker consumers should get a break. Costs will vary widely from state to state and for different types of consumers.

Wall Street Journa: “Pricing Glitch Afflicts Rollout of Online Health Exchanges” Less than two weeks before the launch of insurance marketplaces created by the federal health overhaul, the government's software can’t reliably determine how much people need to pay for coverage, according to insurance executives and people familiar with the program.