Obamacare: Study Reveals Two-Thirds of Hospital Networks Offered Are Narrow or Ultra-Narrow

“To keep premium prices down for individuals and small businesses buying coverage through new online marketplaces, insurers have created smaller networks of hospitals. But consumers and policy experts have wondered, just how small?

Turns out, many are very small.

“About two-thirds of hospital networks on the exchanges are narrow or ultra-narrow,” said Paul Mango, a director at the consulting firm McKinsey & Co., at a conference of insurance industry leaders in Washington Thursday.


Based on research he says it took his team weeks to develop, Mango said the majority of the lowest-priced insurance plans sold through the new online marketplaces use very small networks of hospitals. The study did not evaluate doctor participation in those networks.

The issue of whether doctors or hospitals are in a network is often of utmost importance to consumers choosing an insurance policy. But prices also are important.

Mango said his research looked at 20 urban areas representing about 25 percent of the uninsured. To develop a definition of broad or narrow, McKinsey identified the biggest 20 hospitals by their number of beds. Insurance plan networks with 15 or more big hospitals were tagged as broad networks. Those with 7 to 14 were considered narrow, and those with 6 or fewer of the top 20 were considered ultra-narrow.” - Marketplace Plans’ Networks Are Very Small, Study Finds. Kaiser Health News, 12/12/2013

　

Link to the entire article appears below:

http://capsules.kaiserhealthnews.org/index.php/2013/12/marketplace-plans-networks-are-very-small-study-finds/?referrer=search

Obamacare Provider Networks: The Networks Look Like Medicaid Networks? One has Signed Up for “Medicaid Plus“?

‘Many plans being offered now on the new insurance exchanges sharply limit the number of hospitals where services are covered, according to a new McKinsey & Co. report. Insurers are making a bet that price is more important to consumers than choice, and limiting the number of hospitals and doctors allows them to keep the cost of a plan as low as possible. Many of the new plans offered still are more expensive than current plans because they offer more benefits.’

‘According to the McKinsey report, which looked at federal and state-run insurance exchanges in 20 cities including Los Angeles, Atlanta and Houston, about 60% of health plans offer coverage at a smaller number of hospitals than comparable current individual plans. McKinsey identified 120 health plans in those markets by examining federal and state exchange filings, as well as provider information listed on individual insurer and hospital websites. Some of these new plans limit coverage to one or two large hospitals.

The number of hospitals accepting insurance from a consumer who buys coverage on the exchange could be 60% lower than the number of hospitals in current individual plans, according to the McKinsey report, which included the 20 largest hospitals in each market that it measured.

Consumers can still buy plans on the exchanges that offer coverage at a wide network of hospitals, but they cost significantly more, McKinsey said. In a market where the same insurer offers two separate plans—one with broad hospital access, one with limited options—the more comprehensive coverage costs 26% more, McKinsey said.’

‘Leading research and teaching hospitals, such as Cedars-Sinai, the University of Chicago Medical Center and MD Anderson Cancer Center in Houston, are cut out of most plans sold in their home states. That move "is built on the premise that hospitals are commodities," said Thomas M. Priselac, CEO of Cedars-Sinai Health System, which is available on just one of seven middle-tier plans sold in Los Angeles. "That's just not true."‘

‘Consumers who need complex procedures like heart transplants will still be able to get them because their insurers will contract with hospitals that offer them.

Still, "when you need an organ transplant, it's a matter of life or death—do you want your insurance company calling us, working out a deal?" asked David T. Feinberg, CEO of the UCLA Hospital system, which includes Ronald Reagan. The hospital is included in just two of seven middle-tier health plans sold in the Los Angeles market.’ - Shrinking Hospital Networks Greet Health-Care Shoppers on Exchanges, WSJ, 12/13/2013

Link to entire article appears below:

http://online.wsj.com/news/articles/SB10001424052702304202204579256621005722460


　

　

　

　

　

　

　


　

ACA: Where Choice is Job 57!

“Federal officials often say 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.

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those providers will, in many cases, be paid less than what they have been receiving from commercial insurers.

Some consumer advocates and health care providers are concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.” - Lower Premiums to Come at Cost of Fewer Choices, New York Times, 09/23/2013

Link to entire article appears below:

http://www.nytimes.com/2013/09/23/health/lower-health-insurance-premiums-to-come-at-cost-of-fewer-choices.html?ref=politics