Topics: Obamacare

Exography: Survey finds doctors rebelling against Obamacare, famous hospitals declining to join

By |

Who's in and who's out?

We talked with insurance agents across the country to hear how Obamacare is affecting their areas. Click a city to see which insurance companies, doctors and hospitals agents say are in and out of the Obamacare exchange in their areas. Insurance companies who have chosen not to be part of the exchanges are highlighted in red.
Health,Watchdog,Richard Pollock,Barack Obama,Obamacare,EXography,Accountability,Healthcare.gov,Technology,Health Care Exchanges,HHS

Obamacare applicants across the country are finding their premiums are tripling, their favorite doctors aren't available, the physicians they can see are often far away and many prestigious hospitals offering specialized care are off-limits to them, according to a Washington Examiner survey of health insurance agents and brokers across the country.

Agents associated with the National Association of Health Underwriters were contacted in 16 cites across the country.

The agents were all certified by state insurance regulators to sell health insurance policies within and without the Obamacare exchanges.

Their responses provide an alarming picture of the profound changes Obamacare is forcing on patients and health care providers.

In parts of California, for example, low reimbursement rates have resulted in a doctor rebellion, as nearly seven out of 10 doctors refuse to participate in the exchanges.

San Diego broker Neil Crosby told the Examiner that "65 to 70 percent of the providers have declined the reimbursement schedules the carriers are offering. They will not be providers in the exchange marketplace.”

Similarly, agent David Fear in Sacramento said, "Roughly a third of the doctors are going to be accepted in the networks. I’m finding very few specialists in either the Anthem or Blue Shield networks.”

Larry Harrison, an agent in Las Vegas, said the “lion’s share” of doctors there are staying away from the exchanges.

On the other side of the country, broker Carol Taylor of Roanoke, Va., estimated that participating doctor networks there are shrinking by 70 percent in the exchange plans.

Meanwhile, nationally known health insurance providers like United Healthcare, Aetna, Cigna and Coventry are staying out of the Obamacare exchange marketplaces.

Other well-known companies such as Blue Cross Blue Shield are in, but are sharply narrowing their networks to exclude many doctors, as well as elite hospitals.

As a result, well-known hospitals like Los Angeles' Cedars-Sinai, New York's Memorial Sloan-Kettering and the NewYork-Presbyterian Hospital will be out of reach for many exchange patients.

In Naples, Fla., Physicians Regional Hospital will not be available to exchange enrollees. Its parent company purchased the former Cleveland Clinic's Florida facility in Naples in 2006.

In Georgia, Humana exchange patients are discovering the insurer operates only one approved hospital in the entire state.

The changes wrought by Obamacare are especially hard on patients in rural areas because the new program often puts available medical help far away.

Roanoke's Taylor said, “just an hour away, in Lynchburg, there is a lot of disruption in that area. They have no providers in that area. They have to drive an hour to see a physician.” None of Lynchburg's three hospitals are available to exchange patients.

Fear in Sacramento estimated that Anthem exchange customers who live in the Sierra Nevada foothills will find their closest hospital is 50 miles away.

David Mordo, a Fair Haven, N.J, agent, said his customers wonder if they will have any access to their doctors:

“That’s obviously a concern. Will my doctor be in? Will my hospital be in? If my hospital is not in, how long do I have to travel to go to a hospital that is in?”

While health care services for Obamacare customers are being curtailed, premiums are skyrocketing for many of them.

Mark Brown, an agent in Joliet, Ill., said, “if they enroll in the Blue Cross Choice, it’s smaller, much smaller than what it was before. But the prices of these plans have gone up considerably, about 30 to 40 percent."

Donna Hill in Duluth, Ga., just outside Atlanta, said premiums are 80- to 100-percent higher than those under current policies that offered wider networks.

Gregg Westcott, an agent in Grand Rapids, Mich., said his customers are seeing $300-per-month premiums mushrooming to $900 and $1,400.

Agent Larry Pahlke’s Chicago customers are seeing monthly premiums increase from $425 to $750. “These are really scary numbers for a guy like me,” Pahlke said.

The news isn't uniformly bad. Connecticut’s medical society sponsored the health co-op there, so there is little likelihood of a doctor shortage there. And Utah's doctor participation rate is 92 percent.

But New Jersey's Mordo echoed comments from many of his colleagues across the country when he told the Examiner that “outside the exchange, the provider networks are large. Their network of doctors and hospitals is formidable. It’s very formidable. Inside the exchange, we’re liable to see reduced providers and hospitals.”

The assessments of agents and brokers interviewed by the Examiner are necessarily limited to their particular markets and so should not be viewed as constituting a comprehensive perspective.

Even so, they provide important insights into how the American health care system is being changed by Obamacare.

  1. Naples/Ft. Myers, Fla.

    Agent: Wayne Sakamoto, Health Insurance Interactive, Naples, Fla.

    Percent of insurance companies in exchange: 17 percent

    Insurance companies in exchange: Blue Cross of Florida

    Insurance companies not in exchange: United Healthcare, Humana, Aetna, Assurant, Cigna

    Hospitals: Naples Community Hospital is in the exchange plan. Physicians Regional Hospital, owned by Health Management Associates, is not in the exchange.

    Doctors: 70 percent of doctors are not in the exchange. Of the 900 physicians in Collier County, only 263 doctors are in the exchange network.

    The number one thing that clients/consumers are really looking for is access. Access is probably number one and very critical over anything else. In Florida, our carriers are offering plans in different counties, and in Collier County, inside the exchange, we have only one carrier — Blue Cross of Florida. Outside of the exchange in Collier County, you're looking at carriers like United Healthcare, Humana, Aetna and Assurant Health.

  2. Raleigh, N.C.

    Agent: Liz Gallops, JBA Benefits, Raleigh, NC.

    Percent of insurance companies in exchange: 29 percent

    Insurance companies in exchange: Blue Cross, Coventry

    Insurance companies not in exchange: United Healthcare, Humana, Assurant, Aetna, Cigna

    Hospitals: Full access

    Doctors: Access to Coventry physicians "has dramatically changed."

    The Blues did introduce a new plan design that has a more limited network for preferred in-network providers versus nonpreferred network providers. Coventry has decided only to participate in about 40 percent of our counties in North Carolina, and they are operating in the ACO platform. Before, they operated on a point-of-service network, which was much greater. Now they are operating on an ACO network, with [a] limited number of physicians and hospitals. You can go outside of the ACO, but you'll be paying significant[ly] higher fees. We've seen some constriction to access to physicians.

  3. Springfield/St. Louis, Mo.

    Agent: John Osborn, Osborne & Associates, Springfield, Mo.

    Percent of insurance companies in exchange: 33 percent

    Insurance companies in exchange: Anthem, Coventry One

    Insurance companies not in exchange: United Healthcare, Assurant, Golden Rule, Humana One

    Hospitals: Access mainly to hospital-employed doctors. Doctors outside of the hospital may not be able to provide care to exchange patients.

    Doctors: Barnes Jewish in St. Louis will not participate. Coventry One will allow patients to use one hospital in southwest Missouri. Coventry One will use Mercy Hospital in St. Louis. Anthem will use CoxHealth hospitals and clinics.

    Anthem is no longer accessing Barnes Jewish Hospital in St. Louis, which is a huge hospital system and they have very few exchange plans on healthcare.gov. It's very minimal enrollment at best right now. We have a lot of network incompatibilities that a lot of folks, they just can't afford to go to a particular hospital anymore because the only carrier on the exchange that has network access to the Cox hospital will be cost-prohibitive. They will have to change their doctor in order to get a doctor they can afford.

  4. Las Vegas

    Agent: Larry Harrison, Insure Nevada, Las Vegas

    Percent of insurance companies in exchange: 38 percent

    Insurance companies in exchange: Anthem (HMO), Health Plan of Nevada, Nevada Health CO-OP

    Insurance companies not in exchange: Aetna, Coventry, Humana, Anthem Blue Cross (PPO), Assurant

    Hospitals: All three St. Rose Dominican Hospitals will not participate in the exchange.

    Doctors: 30 percent of the HPN doctors will not be in the exchange

    There is going to be a narrow network of hospitals. As for doctors staying out, I would say the lion's share. I have been told it is going to be a very skinny network.

  5. New Jersey

    Agent: David Mordo, Walsh Benefits, Fair Haven, N.J.

    Percent of insurance companies in exchange: 43 percent

    Insurance companies in exchange: AmeriHealth, Horizon Blue Cross Blue Shield, Health Republic Insurance of New Jersey CO-OP

    Insurance companies not in exchange: Aetna, Oxford, Cigna, Qualcare

    Hospitals: Most hospitals participating

    Doctors: 75 to 80 percent of doctors in three hospitals

    Outside the exchange, the provider networks are large. Their network of doctors and hospitals is formidable. It's very formidable. Inside the exchange, we're liable to see a reduction of providers and hospitals. That's obviously a concern to the consumer, when and if they go into the exchange: Will my doctor be in; will my hospital be in? If my hospital is not in, how long do I have to travel to go to a hospital that is in?

  6. Grandville/Grand Rapids, Mich.

    Agent: Greg Westcott, Grandville, Mich.

    Percent of insurance companies in exchange: 43 percent

    Insurance companies in exchange: Blue Cross Blue Shield, Priority Health (HMO), Consumers Mutual Insurance of Michigan CO-OP

    Insurance companies not in exchange: Assurant, United Healthcare, Aetna, Humana

    Hospitals: All hospitals

    Doctors: Not sure

    The prices are really high. They are substantially higher, especially if you have family rates and you're younger — a family under the age of 45 where there's a mom and a dad and three kids. These are really scary numbers for a guy like me. My average client is about $300 to $350 of fixed cost of premium (per month). And these numbers are looking like anywhere from $900 to $1400 of premiums now.

  7. Olympia, Wash.

    Agent: Dan Eich, Oak Insurance Services, Olympia, Wash.

    Percent of insurance companies in exchange: 43 percent

    Insurance companies in exchange: Premera Blue Shield, Bridgespan, Group Health

    Insurance companies not in exchange: Aetna, Cigna, United Healthcare, Regence Blue Cross Blue Shield

    Hospitals: Childrens Hospital in Seattle was blocked from the exchange.

    Doctors: Not sure

    If someone is looking outside of the exchange, they have certainly more plans, more network plans, wider choice. But once moving into the exchange, especially in certain parts of Washington state, there are very few plans available. What we found is that there were only limited willing participants from insurance companies that were going into that market. The problem isn't so much that the selection of hospitals and doctors was limited, the problem was there was only one plan, especially in the rural areas that individuals would have to choose from within the exchange.

  8. Duluth/Atlanta, Ga.

    Agent: Donna Hill, E2E Benefits, Duluth, Ga.

    Percent of insurance companies in exchange: 56 percent

    Insurance companies in exchange: Humana, Blue Cross (HMO), Kaiser, Aliant, Ambetter Health

    Insurance companies not in exchange: Aetna, Cigna, United Healthcare, Coventry

    Hospitals: Humana has only one hospital in Atlanta — Northside Hospital — which is Humana's only exchange hospital in the state. There are about 60 hospitals in the Atlanta. There also are no exchange hospitals available in nearby Gwinnett County, with a population of 805,000

    Doctors: Not sure

    We have only a few networks that work well over here. I know I'm in Gwinnett County, which is a huge [county]. It's two of the biggest of the Atlanta counties, and our hospital is not on there. Blue Cross is much more limited than before. It's not god-awful, but it's much more limited than before. The Humana hospital has only one hospital in the entire state. The average [premium] for the exchange is about 80 to 100 percent higher than last year.

  9. San Diego

    Agent: Neil Crosby, Warner Pacific Insurance Services, San Diego

    Percent of insurance companies in exchange: 57 percent

    Insurance companies in exchange: Sharp Healthcare, Blue Shield of California, Kaiser, Health Net

    Insurance companies not in exchange: United Healthcare, Aetna, Cigna

    Hospitals: Prestigious hospitals such as Cedars-Sinai and UCLA Medical Center will not be available to exchange patients.

    Doctors: Low: 65 to 70 percent of doctors are refusing to participate in the exchanges.

    Just the numbers I've heard from some of our carriers: On average, most of them are estimating that they will have between 30-35 percent of the providers in the individual exchange network rather than in the individual private network. So 65-70 percent of the providers have declined the reimbursement schedule the carriers [are] offering. They will not be providers in the exchange marketplace.

  10. Sacramento, Calif.

    Agent: David Fear Jr., Fear Corp., Roseville, Calif.

    Percent of insurance companies in exchange: 57 percent

    Insurance companies in exchange: Western Health Advantage (HMO), Kaiser (HMO), Anthem (PPO), Blue Shield of California (PPO)

    Insurance companies not in exchange: United Healthcare, Aetna, Cigna

    Hospitals: In the Sierra Nevada foothills (population: 100,000-200,000), Anthem doesn't have a hospital within 50 miles.

    Doctors: About 30 percent will participate. The biggest problem will be with specialists.

    The networks are definitely significantly smaller than they were before. Roughly a third of the doctors are going to be accepted in the networks. I'm finding very few specialists in either [the Anthem or Blue Shield] network.

  11. Niantic/New London, Conn.

    Agent: John Parker, Parker Agency, Niantic, Conn.

    Percent of insurance companies in exchange: 60 percent

    Insurance companies in exchange: Connecticare, Anthem Blue Cross Blue Shield, HealthyCT CO-OP

    Insurance companies not in exchange: Aetna, Cigna

    Hospitals: Most are participating.

    Doctors: Nine of 32 Connecticut hospitals are not participating in the exchange. Lawrence + Memorial, a large regional acute care hospital with 280 beds and serving 250,000 people, will not be part of the exchange.

    In all cases, there are fewer providers in the health insurance marketplace networks. HealthyCT, the CO-OP, [is] hurting with the hospital enrollment. Access HealthyCT staff really pushed hard to have adequate networks, and they have 'adequate' networks. We're not down to the skinny networks like California.

  12. New York City

    Agent: Kyle J. Kautzmann, EBNY Insurance Services, New York City

    Percent of insurance companies in exchange: 60 percent

    Insurance companies in exchange: Only HMOs available: Oxford, North Shore-LIJ CareConnect Insurance Company, Affinity, Emblem, Health Republic Insurance of New York CO-OP. No PPOs exist in the New York exchange.

    Insurance companies not in exchange: Aetna, Cigna, Blue Cross Blue Shield, Oscar

    Hospitals: In the exchange, only limited coverage is available: Memorial Sloan-Kettering, NYU Langone Medical Center, NewYork-Presbyterian, Mount Sinai

    Doctors: A lot less

    'Oh, I want this doctor and this hospital.' When you look at it, it looks good on paper. They call up their doctors and they say, 'We accept these carriers,' and you say no — you have to ask them the specific network. And then they say, 'No, we don't accept that.' The top name hospitals, it's tough — like Sloan-Kettering, the top cancer hospitals. Out of close to ten carriers, only three might accept Sloan-Kettering. The other hospitals offering only limited coverage are NYU Hospital, NewYork-Presbyterian and Mt. Sinai. These are the hospitals people want. And it's expensive for what people are getting.

  13. Chicago

    Agent: Larry Pahlke, Pahlke & Pahlke, Chicago

    Percent of insurance companies in exchange: 60 percent

    Insurance companies in exchange: Blue Cross Blue Shield, United Healthcare, Humana, Aetna, Coventry, Land of Lincoln Health CO-OP

    Insurance companies not in exchange: Aetna, Coventry, Assurant, Starmark

    Hospitals: University of Chicago Medical Center, North Shore Medical Center, Evanston and Ann & Robert H. Lurie Children's Hospital of Chicago are not in the exchange under lower premiums.

    Doctors: Not sure

    We do a lot of business with Blue Cross Blue Shield. They have a standard PPO network, which is large. Their smaller PPO network, which is the Blue Choice, they've narrowed some of the doctors and some of the network. I had a client [who] had a large network with Blue Cross Blue Shield. They got the renewal and [the] increase was pretty substantial. She had a premium from $447 per month. It went to $750 to have something similar to what she has.

  14. Naperville/Joliet, Ill.

    Agent: Mark Brown, M. Brown & Associates, Naperville, Ill.

    Percent of insurance companies in exchange: 75 percent

    Insurance companies in exchange: Humana, Blue Cross Choice, Aetna

    Insurance companies not in exchange: United Healthcare

    Hospitals: Two in the Joliet area: Presence St. Joseph Medical Center and Silver Cross.

    Doctors: Smaller networks, but no numbers

    If they enroll in the Choice [plan], it's smaller, much smaller than what it was before. But the prices of these plans have gone up considerably, about 30 to 40 percent. Now you can get into the network and you find you can't afford it.

  15. Salt Lake City, Utah

    Agent: Ernie Sweat, Fringe Benefit Analysts, Layton, Utah

    Percent of insurance companies in exchange: 75 percent

    Insurance companies in exchange: SelectHealth, BridgeSpan Health, Humana, Altius, Arches Health Plan CO-OP, Molina Healthcare (Medicaid)

    Insurance companies not in exchange: United Healthcare, Regence Blue Cross Blue Shield

    Hospitals: All hospitals

    Doctors: 92 percent

    We're just trying to get a handle on the narrowing of networks. The Humana plan that's being offered is using one hospital system. The BridgeSpan plan is only offering two of the four hospitals.

  16. Roanoke, Va.

    Agent: Carol Taylor, D&S Agency, Roanoke, Va.

    Percent of insurance companies in exchange: 80 percent

    Insurance companies in exchange: Anthem, Aetna, Coventry, Optima

    Insurance companies not in exchange: United Healthcare

    Hospitals: All three Lynchburg hospitals are not in the exchanges; patients have to travel one hour to go an approved hospital.

    Doctors: Anthem, the largest insurer, narrowed its network by 70 percent. Other smaller carrier networks remain the same.

    Just an hour away, in Lynchburg, there is a lot of disruption in that area. They have no providers in that area. They have to drive an hour to see a physician. We are telling people, 'Don't think the Anthem network that you're used to having is actually what you're going to get.' There's not even a hospital in Lynchburg for them to go to. Beyond Lynchburg, throughout the entire area, there are quite a few access difficulties. In Roanoke, there are limited networks as well. In Anthem, you would have to pick which hospital grouping that you want, but of course you can't see anything on the healthcare.gov exchange.

View article comments Leave a comment