Insurers Limiting Doctors, Hospitals in Health Insurance Market

[Duaine]

Insurers in California's new health insurance exchange are holding down premiums by limiting choices, raising concerns that patients will struggle to get care

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.

New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.

These diminished medical networks are fueling growing concerns that many patients will still struggle to get care despite the nation's biggest healthcare expansion in half a century.
Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.

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

To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.

Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.

But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.

Insurers limiting doctors, hospitals in health insurance market - latimes.com

 

[RayNY]

No one will struggle to find care, just go to the provider search, fill in some boxes, and voila, you found a provider!

Obtaining care, on the other hand, might be painful. More people, with less knowledge of what's going on, seeing less doctors, and dealing with their pent-up demand. Top it off with some "my deductible is WHAT!?" flavored frosting and we have a PPACA cupcake.


On a serious note, some of the preliminary network's I've seen for NY are 25-90% smaller than existing, to give you an idea of the other side of the country. This isn't a local/statewide theme, it's nation wide. I already hear about issues finding doctors under the current plans...

 

[AllenChicago]

November 20, 2015

The government is now saying that it might help insurers improve their bottom line if they reverse the "narrow network" trend. I wonder who has to act first in this arrangement... Insurers, or the Government?

"Federal regulators on Friday proposed potential solutions to some of the Obamacare problems that led UnitedHealth Group to warn it may exit the health exchanges before 2017, but the government also may make it tougher for insurers to limit the number of doctors and hospitals in their plan networks.

The proposed rule from the Centers for Medicare and Medicaid Services would reduce insurers' administrative costs, maintain fee levels and improve the accuracy of a payment formula designed to minimize insurers' risks when taking on new customers.

"The Obama administration has to stabilize this market if they want there to be an individual insurance market in this country five years from now," says Dan Mendelson, president of consulting firm Avalere Health, which has more than a dozen insurance clients.

Friday's proposal doesn't make clear whether the administration is committed to doing so, Mendelson said, but it does show the administration can act without turning to Congress.""

Full Story: Insurers: Obamacare changes needed soon to protect us from losses

ac

 

[somarco]

Is this the same govt that promised reinsurance to cover losses?

 

[RayNY]

The reinsurance wasn't promised, it was promised to work, but didn't.

Not the gov'ts fault the carriers all mis-priced their premium and there was only enough excess profit to cover 13% of the losses.

This plan would involve printing money and just handing it to insurers from the looks of it.

To quote the proposed rule (page 18 for overview, 51 for detail): https://www.cms.gov/cciio/resources/regulations-and-guidance/downloads/cms-9949-p.pdf
"In this proposed rule, we solicit feedback on potential revisions to the allocation of
reinsurance contributions collected and we suggest an approach such that the contributions
collected under that program are allocated first to the reinsurance pool and administrative
expenses, and second to the U.S. Treasury"

As far as I can tell, reinsurance would first come from the reinsurance pool (The $63 fee), and MLR corrections pool, and then direct from the treasury.

They propose allowing MLR to be changed by 2% (78% medical, 22% admin) as well. This basically just means they'll let renewals be 2% higher than usual.

The funniest part? "This
proposal could lower premiums by reducing the uncertainty associated with reinsurance
payments to non-grandfathered plans in the individual market that are eligible for such payments
under 45 CFR 153.234." No worries about actually pricing products correctly, only concern is on artificially keeping premium as low as possible to make it look like ACA is working.

 

[ActuaryGuy]

You guys are mixing up your Rs.

Reinsurance works "okay" and funds come from assessments to carriers. There are questions of whether or not the assessments are sufficient but this is generally not a major issue for carriers.

Risk adjustment is self-contained and just passes money between carriers, so no funding questions here. Specific carriers have issues because some expected to have "worse" risks and receive money but instead got better risks and were surprised to have to pay in instead.

Risk Corridors are the biggest problem. This too was supposed to be self contained with the profitable winners paying in to help mitigate the losses of the losers. But not enough winners in 2014 resulting in the 13% prorated payments.

 

[somarco]

MLR, SEP, dictating rates and rating basis, browbeating carriers when HHS Sebelius said the rates were too high, etc all but guaranteed there would be no winners.

The carriers were fools for buying into this BS from the start and just plain stupid for agreeing to play once "we passed the bill in order to know what was in it".