Slim Pickings on the Health Exchange

by Jillian Kay Melchior

For those unfortunates forced on the health exchange, provider options are going to be limited, as the New York Times reports:

Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers. From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.

And the story references a new report by the Health Research Institute of PricewaterhouseCoopers, which found that in California, Illinois, Indiana, Kentucky, and Tennessee, insurers often didn’t include major medical centers in their offerings:

“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”

Not only will patients have fewer options for providers, but “those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.”

Senior citizens’ experience is, of course, instructive; those on the new exchanges can also expect to experience access problems.

Already, when doctors treat Medicare patients, they essentially take a 20 percent pay cut compared to when they treat those who use private insurance. It looks like many patients with plans on the exchange may be at a similar disadvantage.

As a result, in many states, doctors already limit the number of Medicare patients they see, and according to a recent MedPac survey, about one in four Medicare beneficiaries struggle when they try to find a new primary-care doc. Americans who get their health insurance on the exchanges should probably expect longer wait times for appointments and less face time with doctors.

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