Heasley Insurance

News Archives

Obamacare Exchanges Offer Medicaid-Type Provider Networks? Glorified Medicaid?

�Think of an insurance plan as having three main components: (1) a premium, (2) a list of covered benefits and (3) a network of doctors, hospitals and other providers. Under the Affordable Care Act, there is very strict regulation of benefits�right down to free contraceptives, questionable mammograms and non-cost- effective preventive procedures. At the same time health plans have been given enormous freedom to set their own (community rated) premiums and choose their own networks. They are using that freedom in yet another way to attract the healthy and avoid the sick.

In the ObamaCare exchanges, the insurers apparently believe that only sick people (who plan to spend a lot of health care dollars) pay close attention to networks. Healthy people tend to buy on price. Thus, by keeping fees so low that only a minority of physicians will agree to treat the patients, some insurers are able to quote very low premiums. They are banking on attracting the healthy and they may even have the good luck to scare away the sick.

Community rating is what makes this strategy work. In the ObamaCare exchanges, if I am healthy why wouldn�t I buy on price? If I later develop cancer, I�ll move to a plan that has the best cancer care. If I develop heart disease, I�ll enter a plan with the best heart doctors. And these new plans will be prohibited from charging me more than the premium paid by a healthy enrollee. (See a more comprehensive analysis.)

As a result, we are getting a race to the bottom on access�with private plans in the exchanges looking increasingly like Medicaid, just as they do in Massachusetts.

The Obama administration doesn�t seem to be bothered by this development. In fact they have been touting the fact that the premiums have been lower than expected, even though the reason is that the networks are narrower and skimpier than expected.

Think how different this is from what we were promised. During the 2008 election, every serious candidate for the Democratic presidential nomination repeated the �universal coverage� mantra repeatedly�and on the left �universal coverage� means universal access to care. No candidate even hinted that access to providers might not be any better than it is under Medicaid. - Obamacare�s Insurance Exchanges Will Foster a Race to the Healthcare Bottom, John C. Goodman, The Independent Institute, 10/03/2013

Link to the entire article appears below:

http://www.independent.org/newsroom/article.asp ?id=4739