Many Healthcare Providers Not in ObamaCare Networks

By:  Michael Tennant
11/04/2013
       
Many Healthcare Providers Not in ObamaCare Networks

ObamaCare may be making health insurance more affordable for some people, but at the expense of their choice of providers.

No one denies that the Affordable Care Act (ACA), aka ObamaCare, has made health insurance more affordable for some, primarily those who have chronic conditions or are eligible for generous taxpayer subsidies. But all the insurance in the world is worthless if no one will accept it — a truism that Americans buying coverage on ObamaCare’s insurance exchanges may soon experience, much to their chagrin.

Insurance companies are finding themselves hamstrung by the healthcare law’s twin mandates of guaranteed issue (covering all applicants regardless of pre-existing conditions) and community rating (charging the same premiums to beneficiaries regardless of their risk). Both requirements virtually ensure that those with the greatest need for expensive, long-term care will buy coverage, but the community-rating mandate further discourages the healthy from buying coverage because their previously low rates will be forced to rise to meet the rates of the sick. Add to that the fact that the ACA forbids insurers to impose any limits on benefits, and it’s clear that payments will outstrip premiums in fairly short order if nothing is done to rein in costs.

Insurers, therefore, are doing their utmost to minimize their exposure now. One way they are doing that is by creating narrow networks of doctors and hospitals whose services they will reimburse. This means, of course, that many providers will be left out.

“That’s a big frustration to my clients who heard their President promise that if you like your doctor you can keep them,” New Hampshire insurance broker Thomas Harte told CNN. “Sure, you can keep them if you pay cash for their services. But if you want your new insurance to cover that doctor visit, forget it. You’re going to have to switch.”

Harte’s clients have plenty to worry about. According to the Concord Monitor, just one insurer, Anthem Blue Cross Blue Shield, is offering plans on the Granite State’s exchange, and it has contracted “with [only] 16 of the 26 acute general care hospitals in the state.” Concord Hospital was not among them, leaving residents of the state capital who buy coverage through Anthem with the option of paying expensive healthcare bills or driving to Manchester, the nearest in-network hospital.

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