Insurers to Limit Exchange Doctor Networks

In an effort to control insurance premium costs, major insurance companies in California are limiting the number of doctors and hospitals that will be available to patients obtaining health plans in the new state health insurance marketplace.

In an effort to control insurance premium costs, major insurance companies in California are limiting the number of doctors and hospitals that will be available to patients obtaining plans in the new state health insurance marketplace. This limited network of providers is raising concern in affected consumers who now could see longer wait times, face a scarcity of specialists, and possibly even lose their long-time doctors.

"These narrow networks won't work because they cut off access for patients," Dr Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles said in a recent article. "We don't want this to become a roadblock."

The insurance company Health Net notes that state exchange customers based in Los Angeles County would be limited to an estimated 2300 primary care doctors—less than one third of doctors offered to workers on private employer plans. Consumers in San Diego would have access to only 204 primary care doctors.

Some health policy experts argue that this narrow access will affect costs for patients with chronic conditions, such as diabetes or hypertension. They reason is because they will not be able to see their doctors regularly or receive proper follow-up care.

"We are nervous about these narrow networks," said Donald Crane, chief executive of the California Assn. of Physician Groups. "It was all about price. But at what cost in terms of quality and access? Is this contrary to the purpose of the Affordable Care Act?"

Lanhee Chen, research fellow at the Hoover Institute at Stanford University, says the premium raises should come as no surprise. Numerous restrictive federal regulations require more of insurers, including covering every consumer regardless of pre-existing conditions.

“In tension with these economic and regulatory factors working to raise premiums is the political pressure being applied by the Obama administration, particularly in states like California, to keep premiums as low as possible,” said Mr Chen. “Physicians and physician organizations in California have expressed concerns that these limited provider networks may most adversely impact minority communities, the very ones that the healthcare law purports to help most. Those concerns reflect the fact that while some coverage is better than none at all, Obamacare’s supporters have dramatically oversold the supposed benefits of the law.”

Around the Web

Insurers Limiting Doctors, Hospitals in Health Insurance Market [Los Angeles Times]

Obamacare Doctor Rationing Begins in California [Bloomberg]