Getting access to a preferred, in-network doctor is getting harder all the time. Three big stories about access blocks under the Affordable Care Act came out this week. First, the NYT profiles the troubling rise of contract ER doctors. The emergency medicine departments in many hospitals now employ doctors who are out-of-network for a given insurer, even when the ER itself is listed as “in-network” for that same insurer. The result is that even patients who have the ability to choose an ER in an in-network hospital often wind up with out-of-network doctors treating them—and large, unanticipated, out-of-pocket bills as a result:
When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield — Texas’s three biggest insurers — had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found. […]When emergency medicine emerged as a specialty in the 1980s, almost all E.R. doctors were hospital employees who typically did not bill separately for their services. Today, 65 percent of hospitals contract out that function. And some emergency medicine staffing groups — many serve a large number of hospitals, either nationally or locally — opt out of all insurance plans.
The ACA does nothing to address this trend, which is just one example of the barriers to access popping up all across the U.S. health care system. The LA Times reports that, despite several lawsuits challenging it, California intends to stick with its narrow doctor networks for ACA plans next year. Even worse, some insurance companies are planning to cut the number of in-network providers even further. There is still no registry that would allow people to make a comprehensive assessment of which doctors will be covered under their ACA plans, a gap which caused a lot of confusion for patients in the last year.Nor are those insured through the exchanges the only ones facing access problems. A Department of Health and Human services report on the ACA’s Medicaid expansion finds that many Americans newly insured through the program often have to “wait for months or travel long distances” to get care, according to the NYT. Though the federal government requires states to ensure “adequate access to all services covered,” the definition of “adequate access” is left to the states. This access problem for Medicaid recipients is not new, as Avik Roy repeatedly points out in How Medicaid Fails the Poor, and has been exacerbated as large numbers of people have joined the program.In all three of these reports, we see under the ACA a declining level of access to a covered care provider. This is not what progress in health reform looks like.