The first months of 2014 aren’t shaping up to give Obamacare any better publicity than the last months of 2013. Even as enrollment figures skewed toward older people continues to be a live issue, journalists are looking ahead to what comes once people do enroll. At Wonkblog, Sarah Kliff highlights one issue that she says is likely to make Americans “furious” even if it will also lower costs: narrow networks. More:
The move toward narrow networks in Obamacare is a function of the way the law sets up competition between insurers on the exchanges. Insurers can no longer compete by trying to be the best at only covering healthy people, or by endlessly lowering benefits and raising deductibles. So limiting provider choice emerged as one of the few levers that health plans had to hold down premiums. And a lot of them did: approximately 70 percent of the exchange plans are either narrow or ultra-narrow plans, according to a study by McKinsey and Co. The consulting firm defined “narrow” as having at least 30 percent of the 20 largest hospitals in the geographic region not participating in the plan.
As people who had their insurance cancelled move onto plans that include fewer hospitals and doctors, and as the newly insured face fewer options than they might have expected, backlash against the ACA will likely continue. This is what happens when you try to control costs by tinkering with insurance plans and coverage requirements—or even rate-setting. Instead of imposing network changes, we should be thinking about how to change the structure of care delivery such that basic services are cheaper and health care is more convenient for everyone. Seventy-two percent of respondents to a global survey said they would be willing to do basic checkups or primary care over video conference. There’s a good place to start.