Published November 26, 2013
Americans might have to brace for the next broken promise from the president about the Affordable Care Act: that they can keep their doctor.
President Barack Obama has repeatedly promised over the last few years that if consumes liked their current health insurance and doctors they would be able to keep them under the new law, but millions of people scattered across the country have received coverage cancellation notices. And now, experts say the doctor pledge might also not be true.
“Some individual plans are now getting replaced by exchange plans and there is a lot of pressure in terms of what you can do from an underwriting standpoint for insurance companies,” says Vishnu Lekraj, insurance analyst for Morningstar. “Pricing on the exchanges will be more competitive than before, so what the insurers will do is cut back on the number and size of doctor and hospital networks in certain regions.”
The president announced an administrative fix two weeks ago that allows people to keep cancelled policies if the insurance company and state regulators allow it. Insurers were eliminating plans that did not meet the ACA’s 10 essential coverage requirements, which includes prescription benefits and ambulatory services. As a result, individuals will have to purchase coverage on state and federally-run exchanges and could end up with plans that aren’t comparable to what they had.
Due to narrowed provider networks, many individuals will find the president’s promise that they can keep their doctor, may prove untrue.
Lekraj says, for example, certain regions may only have one or two hospitals available on network in order to cut back on profit losses.
Yevgeniy Feyman, Manhattan Institute scholar, says the move to narrow networks is necessary for the insurance industry.
“Insurers have good reason—it is a business decision,” he says. “This is part of conservative reforms that come with tight networkers. Under ObamaCare, insurance companies can’t compete as much with premiums and benefits, but they can compete with network size. So, they will compete that way much more than they did before.”
Smaller networks would be great for consumers, if premiums were low, Feyman adds. The Department of Health and Human Services estimates the average monthly premium for a mid-tier silver plan under the ACA would be about $328 per month, before subsidies. The Kaiser Foundation estimates subsidies are available for those making up to 400% of the federal poverty level, which is about $45,000 for an individual and $94,000 for a family of four.
Under the ACA, individuals are required to have coverage by the end of open enrollment period, which is April 1, 2014. For every three consecutive months in a year they do not have coverage, uninsured people will have to pay a fine of $95 a year, or 1% of their annual income, whichever is higher.
Dr. George Kikano, UH Case Medical Center chairman, Department of Family Medicine and Community Health in Ohio, says narrowed networks will be a major “wake-up call” to policyholders.
“It’s awful, I think we should give consumers a choice for cost and quality,” he says. “And doctors should be reimbursed for their work. We will be doing more [work] here for less.”
He adds that many consumers have not realized how smaller doctor and hospital networks will impact them because after Obama’s administrative fix for the ACA was announced last week, state regulators and insurance companies are still deciding what they are going to allow.
Large hospital systems may also opt to not participate on the exchange networkers in certain areas, he says, because it won’t be cost effective.
“Insurance plans on exchanges are tearing down their physician and hospital panels because there are too many doctors on the networks to control costs,” for insurers, Kikano says.
Feyman says the cancellation letters that millions are getting are just the beginning, and the impact of losing not only coverage, but their trusted doctors, will be widespread.
Stories are already coming out from patients who have lost their doctors. For example, cancer patients are being turned away from the doctors that had kept them alive during treatment, like Edie Littlefield Sundby, who penned an op-ed in the Wall Street Journal on surviving stage-4 gallbladder cancer, and subsequently losing her oncologist as a side effect of ObamaCare.
“I think people are really only starting to realize the impact,” Feyman says. “You are losing your doctor, and it’s not by your own choice.”