The discrepancy between policy and the problems it is supposed to address has never been clearer than in the health care debate. The Seattle Times reports on the network restrictions that are increasingly limiting Washingtonians’ ability to see key doctors and hospitals without incurring major financial risk. The plans offered in the Affordable Care Act exchanges, it turns out, keep premiums low by drastically reducing the number of providers covered. So a lower premium may mean higher health care costs for people with hospitals, doctors, or specialists not covered in-network:
Not only could [patients] wind up paying most or all of the bill [from an out-of-network provider], they would lose the law’s cap on out-of-pocket expenses.
Premera, for example, limits annual out-of-pocket costs for in-network care at $6,350. But out-of-pocket expenses for care outside the network are “unlimited.”
The article goes on to list every insurance company that offers plans in the Washington exchange as well as the hospitals that are in-network for those companies. Pivoting off of that list, Steve Roth points out that two of Washington’s biggest insurers—Primera and Lifewise—don’t have any of the state’s four top specialty hospitals in their networks. If you want the best cancer, trauma, ER, or pediatric care, and your plan is with one of the two biggest carriers in your state, you’re out of luck. Figuring out which insurers cover which providers, and determining from there which provider makes the most sense for you, is a hugely complex and time intensive process, as Roth details in his piece. And even when you’ve done all the research, at the end of the road is the fact that networks keep getting smaller.
This is a trend that the ACA is encouraging, and the acceleration of it is likely to be the next big PR challenge for the Obama administration. More and more we’re seeing that the ACA is doing nothing to reverse the worst trends driving our health care crisis— and that in some cases it’s even intensifying them. Hospitals are getting bigger, prices are going up, the system is getting even more complicated, and networks are getting smaller. Meanwhile, politicians continue to debate reforms that largely fail to address any of these problems.