41 Percent of Obamacare Silver Plans Have “Small” or “Extra Small” Networks
Since the King v. Burwell decision, some have re-branded Obamacare as SCOTUScare, per Justice Scalia’s dissent. However, a better term may be “Medicaid Plus,” because Obamacare beneficiaries have little access to care.
New research sponsored by the pro-Obamacare Robert Wood Johnson Foundation confirms that Obamacare plans have limited access to physicians. The research defines a network as small if no more than 25 percent of physicians in an area are covered, and extra small if it covers less than 10 percent. The results:
- The “narrowness” or size of a network can be quantified, and 41 percent of silver plan physician networks in the ACA marketplace are small or extra small.
- While consumers are likely to select plans with low premiums, they are not fully aware of the characteristics of narrow networks.
- Well-functioning narrow networks will survive only if their characteristics are communicated more clearly to consumers and they are regulated to ensure adequacy.
This paper is extremely well researched, especially given the obstacles facing the researchers:
The provider lists from which these data were gathered were not uniform in their formats and coding. Thus we created a multi-stage cleaning process to integrate all lists into a list with unified formats for names, addresses, and specialties. We converted specialties, listed in more than 6,000 ways, into 47 specialty groups. Given the preponderance of errors in these lists including duplicates, misspellings, typos, misclassifications, and physicians who have relocated or retired, we confirmed unique physicians by matching the information to national provider datasets using a set of algorithms that allow for variation in the data.
And these are professional health policy researchers! Imagine poor Joe or Jane Public trying to choose a plan on an Obamacare exchange. There is a lot of talk about increasing regulation of disclosure of physician networks on exchanges. It will not work.
There is a fundamental conflict of interest between the Obamacare beneficiary and the Obamacare health plan: The plan wants to enroll the healthy. Therefore, it has no interest in making it easy for beneficiaries to determine which specialists are in the network when they sign up, because only beneficiaries with the greatest need for care will seek out that information.
“There is a fundamental conflict of interest between the Obamacare beneficiary and the Obamacare health plan”
One of the consequences of trying to solve our national medical cost/access problem using the tool of medical insurance.
Which, I think, is the reason Obamacare will fail.
Rather one of the consequences of commingling health care reform and and a welfare program.
Who would have thought a voucher for access to care doesn’t equal access to care.
It is the insurance vendor that sets the Provider List both inside the exchange or outside the exchange in “mirror plans,” which are the same plans with the exact same networks sold on the Open Market, yet there is no mention of the mirror plans and access issues with those plans.
Physician lists have been a problem before Obamacare was implemented. But it sounds ominous in headlines…
What is this “open market” of which you speak?
John,
Here in California we have Covered California (the State Exchange) and Direct Sales. For every company that offers insurance in the exchange they have to offer the same plan on the Open Market (Mirror Plans). Same benefits, same networks, no subsidy. They are also able to offer additional plans as well.
Again, it is the insurance company that sets the network not Obamacare.
Thank you. The off-exchange market is hardly an “open market.” Nevertheless, I get your drift. However, if you compare to networks in group market, that is where you see the difference.
The insurers determine the network, but Obamacare is supposed to ensure adequate network access. It does not appear to do so.