New York Times Spotlights Penn 'Narrow Networks' Research
University of Pennsylvania Professor Daniel Polsky's studies of the "narrow network" health insurance options created for the Affordable Care Act's insurance exchanges are featured in an extensive article in the Sunday New York Times.
Polsky, PhD, is Executive Director of Penn's Leonard Davis Institute of Health Economics and a Professor of both Medicine in Penn's Perelman School of Medicine, and Health Care Management in the Wharton School. His Narrow Networks Project has been analyzing the access patterns of the health coverage offered by insurers participating in the ACA's exchanges or marketplaces across the country.
Barriers to care
The New York Times article, authored by senior writer Elizabeth Rosenthal, MD, points out that the ACA's online insurance marketplaces have provided insurance to millions of previously uninsured people but many of those polices come with restrictions that can make it more difficult to actually access medical care.
A major issue is that the exchange policies often limit patients to using only a very narrow group of physicians or provider facilties in their region -- the strategy that gave rise to the "narrow networks" moniker.
The Times reported that when insurers selected physicians and hospital systems for their narrow network products, they "naturally tended to exclude high-cost, high-end hospitals with whom they had little clout to negotiate discounts."
Access to physicians
Polsky's research found that 41 percent of the silver ACA plans offered a "narrow or very narrow" selection of doctors comprising only 25% or less of an area's total pool of physicians. Other researchers reported finding "that exchange plans had 42 percent fewer cancer and cardiac specialists, compared with employer-provided coverage."
Polsky told the Times, "We hear lots of complaints, but we really don't know the extent of the problem because there's still very little data."
"In order to make smart choices," the Times article said, "patients need far clearer and more accurate information about the plans' restrictions as well as which doctors and hospitals are in the network. Yet such information is rarely available, and early research suggests that only a fraction of the doctors listed in some directories are available to see new patients."
"I'm putting my energy into improving transparency and information," Polsky told the Times. "Otherwise we're headed to a poorly implemented strategy that just ticks people off."
New York Times story comments
The online version of the Times article generated more than 900 comments. Here's a sampling of those:
C. Poplin, JD, Maryland
The way to handle out-of-date physician and hospital directories, as well as listings without space for new patients, is to put the responsibility on the party with the best information -- the insurer. If a provider is listed as available when the patient seeks service, the insurance company should pay for the visit, even if the provider is no longer in the network. That way, the insurer will have an incentive to keep its lists up to date.
- - -
Matteo Valenti, Royal Oak, Mich
As a physician I'm happy to see patients that have ACA plans. People who were previously uninsured now have access to care. The plans themselves -- run by for profit companies -- are what troubles me. Extremely limited formularies and many hoops to jump through. These roadblocks to care often impede health and end up raising costs in the long run. But maybe that's the point of a "for profit" -- profit today at all cost without regard for the future.
If I only accepted patients with great insurance who were compliant and healthy I'd have no patients. And the reason I went into medicine in the first place was to help people.
- - -
Steve, Minneapolis, Minn.
You have more options than ever for health insurance plans under Obamacare. But its not going to be free and that is what many people want; free healthcare. Sorry, but if you want high quality, short waits, great facilities, you have to pay for it. Want a wider circle of docs? Pick a richer plan. Go to a health insurance broker and they can help you pick one out. The point of Obamacare is that you shouldn't go bankrupt from a major illness, and it accomplishes that.
- - -
Ice T, Bay Area, Calif.
I am a physician who has practiced in both public and private settings. In California, most of my colleagues accept Medicare but do not accept Exchange plans. Why? Because Exchange plans will reimburse us only around 70% of what Medicare pays. For this simple reason, established physicians like myself who already have a busy practice would be crazy to accept Exchange patients.
Only newly minted doctors and employed physicians are taking Exchange patients because they have no choice. Bernie Sanders is right. Medicare is the only way to go -- because it values physicians 100% for the service that they render, and patients get 100% of the care that they deserve. We do not need to pay 30% to the insurance middleman.
- - -
RKH, Binghamton, N.Y.
The ACA only solved part of the problem, coverage. The rest of the system is still fraught with problems. Employers have seen their shares for premiums skyrocket, co pays and deductibles have also increased drastically, doctors, hospitals and pharmacies have all dramatically increased their rates. We have a horrible hybrid of public-private heath care that is not consumer oriented.
It is simply insane for a human being in the USA to have to sit down and evaluate networks, providers co pays, etc., to pick something as fundamental as health insurance.
- - -
Everyone cannot have a Porsche for the price of a used Hyundai. It is not Porsche's fault for selling high cost cars. And no, healthcare is not different.
- - -
I am a nurse practitioner and have had lots of patients who have ACA plans. These problems with the ACA are not surprising, given the amount of power for-profit insurance companies were given.
Let's look at the ACA as the thin edge of the wedge. We've tried it for a few years, and it has problems. Now candidates are seriously talking about allowing a Medicare buy-in for people over 55. After that? Perhaps the wedge will drive deeper, and we will eventually end up with Medicare for all.
- - -
PeteBart, Naples, Fla.
As one of the self-employed I was getting outrageous annual rate hikes before the ACA and every year since when I've received new rates the increases have been outrageous. However, don't for one minute think that we'd be better off without it -- at least now insurers can't arbitrarily cancel coverage because you actually need to use it! Definitely growing pains but we'll get there, eventually. Not sticking with a public option was the biggest mistake made in putting this together.
- - -
Like it or not, health care is about money first and foremost. The party most affected is the one with no say: the patient. This didn't just occur with Obamacare, it has been a long slow evolution since the federal government became fully involved in 1966 with the advent of the Social Medicare program. The next time you go to the Doctor, notice all the paperwork they, the hospitals and insurers use to eliminate your say in the type, timing and cost of care with you on the hook without any real say during the process. Everyone, in my opinion, should have ready access to timely, effective medical care and yes, there is great cost. As a country we can afford it, but there are just too many powers with their fingers in the pie of self interest, and the patient left to hopefully outlive the effect of ill planned federal programs.
- - -
David Eschelbacher, Tampa, Fla.
The problem is the insurance companies. They are making "strategic" business decisions that hurt consumers, and find loopholes in ACA to do it.
I am a physician and when purchasing individual health insurance for myself, I had a choice between an ACA humana plan and a non-ACA humana plan. They were about the same price with basically the same coverage/deductibles. The only significant difference was that the non-ACA plan had a much larger doctor network. Again, it was the SAME PRICE!
The fact that I had this choice, means that it has nothing to do with cost and everything to do with the insurance company cheating the government (who pays the subsidy) and the poor consumers (who need the subsidy).
This really needs to be fixed. What the insurance companies are doing should be a crime.
- - -