House Republicans seeking to "defund" ObamaCare may find more ammunition for that battle in reports that the lower premiums expected from the insurance exchanges, created under the Affordable Care Act, will be accompanied by fewer choices of doctors and hospitals.
"From California to Illinois to New Hampshire, and in many states in between," the New York Times reported Monday, "insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans." In many cases healthcare providers included in the exchange networks will be paid less than they currently receive. A tighter, narrower network of doctors and hospitals is expected to hold down costs.
"That can be positive for consumers if it holds down premiums and drives people to higher-quality providers," Adam Linker, a health policy analyst at the North Carolina Justice Center, told the Times. "But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network."
Insurers setting up exchanges excluded major medical centers in California, Illinois, Indiana, Kentucky, and Tennessee, among other states, according to a new study by the Health Research Institute of the consulting company PricewaterhouseCoopers. "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."
Cigna is following a similar strategy in the exchanges in which it plans to participate next year in Arizona, Colorado, Florida, Tennessee, and Texas, a spokesman for the company told the Times.
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