Policy: Technology

Healthcare.gov can't tell consumers whether they can keep their doctors

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Watchdog,Richard Pollock,Obamacare,Health and Human Services,Health Care,Medicare and Medicaid,Accountability,Healthcare.gov,Technology

Consumers can't go to healthcare.gov to learn whether their doctors participate in an Obamacare-approved health care plan because the website doesn't include such information.

That's because federal officials were so eager to approve insurer health plans for the exchanges, they didn't ask how many doctors, hospitals, labs and clinics were participating in each plan, according to a key health insurance industry trade association executive.

Federal officials “weren’t counting and saying, 'How many providers do you have, how many hospital systems?'” said Jessica Waltman, senior vice president of government affairs for the National Association of Health Underwriters.

“They didn’t say, ‘OK, that’s enough hospitals for the people in the geographic locations,'” Waltman told the Washington Examiner.

“Under the exchanges, the government did not require health plans to submit detailed network information,” she said. “That’s why the networks aren’t listed on healthcare.gov. When you go to look in at the plan choices, you can’t see the provider networks.”

Consumers must leave healthcare.gov and go to a specific insurer's website to learn which doctors and other care providers participate in its network.

Waltman said federal cost-cutting pressures on insurers are forcing them to reduce the number of doctors and other providers in their networks.

The result is that consumers must choose among provider networks with fewer doctors and hospitals.

That means many consumers who join the Obamacare exchanges won't be able to keep their doctors despite President Obama's repeated promise to the contrary.

Dave Berman, an independent insurance broker in Indianapolis at the brokerage firm Neace Lukens, said people could become confused if they expect their current insurance firm to offer the same network through Obamacare.

“It’s going to be very confusing to consumers who may be used to an insurance company and not knowing that they are going into a restrictive network,” Berman said

Obama admitted recently that he was wrong when he told Americans they could keep their own insurance plan.

Obama has also said on many occasions since 2009 that "if you like your doctor, you will be able to keep your doctor" under the Affordable Care Act.

An estimated five million people who buy their insurance as individuals have had their policies cancelled this year because the policies don't conform to Obamacare requirements.

Millions more are expected to lose their company-provided health insurance coverage next year when Obamacare's employer mandate becomes effective.

In approving plans for the exchange, federal and state officials were required to conduct a “network adequacy review” of each proposed plan, including their providers.

But Waltman said many plans were accepted without details about providers as the Oct. 1 healthcare.gov launch date approached.

Federal health officials were doubly anxious to approve plans last summer when large, high-profile insurance companies like Aetna, United Healthcare, and Cigna announced they would not participate in the Obamacare exchanges.

Obamacare-approved plans must satisfy costly new mandates known as "essential health benefits," but do so while still keeping premium prices low. That in turn forced insurers to reduce their reimbursements to participating doctors and hospitals.

Paul Markovich, CEO of Blue Shield of California, told the Los Angeles Times in May that “the physicians and hospitals that signed up for our network have agreed to accept lower reimbursement specifically to make the exchange more affordable."

Similarly, Blue Cross & Blue Shield of Florida CEO Patrick J. Geraghty told the Wall Street Journal his firm will offer a "tighter, more select group of providers" in its exchange.

"We believe the exchange is going to be driven by price, and therefore we're looking for a lower-price option," Geraghty said.

Another consequence of the federal pressure is that many doctors are refusing to join Obamacare-approved networks.

Neil Crosby of Warner Pacific Insurance Services in California told the Examiner that “65 to 70 percent of the providers have declined the reimbursement schedules the carriers were offering. Therefore, they will not be providers in the individual exchange marketplace.”

With fewer doctors and hospitals available in a network, consumers will also often have to travel further for services.

For example, residents of Saratoga Springs, N.Y., who join provider MagnaCare will have to travel 30 miles to visit the closest primary care physician in the network.

Paul Howard, director of the Center for Medical Progress at the Manhattan Institute for Policy Research, a conservative think tank, said Obamacare was structured so that the only way it could succeed was to slash payments to doctors and hospitals.

Howard described Obamacare's reduced reimbursement levels as "Medicaid Lite” because, he said, the program's reimbursement rates are somewhere between Medicare and Medicaid levels.

“The structure is to really try to keep premiums down as much so you can to get that sweet spot with these essential health benefits,” Howard said.

“So, the only way is for providers to go to start slashing doctors from them and start slashing hospitals and get them to accept these lower payments,” he said.

“They are trying so hard to make it affordable in the exchanges that the health plans have no choice but to have a very narrow network of doctors,” said Grace-Marie Turner, president of the Galen Institute, a free-market health care think tank.

“They have this long list of benefits, and they have to comply with these ridiculous rules,” she said. “There’s only one option — that is to say, ‘Well, you can’t go to too many doctors and hospitals.'”

A spokesman for the federal Centers for Medicare and Medicaid Services, which runs Obamacare, declined to say why healthcare.gov doesn't include information on provider networks.

“Consumers will be able to compare plans to find the one that meets their needs," the spokesman said, adding that "consumer protections in federal and state law require health plans to include adequate networks of providers and essential community providers.”

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