What Will Newly Subsidized (ObamaCare) Insurance Look Like

We have previously reported that subsidized insurance acquired in the health insurance exchange in Massachusetts pays providers only slightly above Medicaid rates. As a result, newly insured Massachusetts residents have limited access to care.

In general, they seem to be going to the same providers (e.g. community health centers, hospital emergency rooms, etc.) they were seeing before health reform.

A new poll of hospital executives reveals that ObamaCare exchanges may produce similar results:

Providers say they worry whether the exchange networks will truly serve the uninsured and broaden the risk pool. Instead, they could result in a huge shift of people currently covered by employer — sponsored coverage into the exchange products marked by narrower networks, less choice, and rates that fail to cover the provision of high-value health care…

56 percent said they would have to make substantial cuts to operating costs or “do something drastic” if Medicaid — level rates prevail for the exchange networks while 11 percent said they would likely decline to participate or simply “go out of business.”

Comments (9)

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  1. Jordan says:

    This is upsetting. Would have been nice for the pollsters to release the full results. Wasn’t able to find it on their site.

  2. Louise says:

    I think so much of what provider an individual uses boils down to non-cost factors now with the market so distorted.

    I usually pick my doctor based on a bunch of convenience-based factors because there’s distorted cost competition so this doesn’t surprise me.

  3. Bill Radiar says:

    I agree with Louise if a clinic is more convenience in location rather than cost, I would pick the convenience in distance rather than dollars.

  4. Bill Radiar says:

    Depending on how bad you feel at the time.

  5. Jim says:

    I dont think it’s surprising that Massachusetts pays providers less than the fair market price. This is just a preview for the rest of the country.

  6. Devon Herrick says:

    One possibility is that subsidized coverage will take the form of a glorified Medicaid plan, with price controlled physician payments. Once premiums continue to rise at a rapid pace, I’m afraid there will be calls for that to happen. This is how Medicare evolved. It’s a public plan, run by private contractors, who reimburse providers at rates tightly controlled by the government.

  7. Susanne says:

    This trend of providers not getting paid enough has already been spreading nationwide. This situation has deprived both insured and non-insured individuals from acceptable health care quality and health care access and some people don’t even have access to physicians at all. This seems like a ticking bomb ready to cause a massive disaster anytime now.

  8. August says:

    Structure the health insurance exchanges so that the subsidy isn’t all or nothing. The incentive to drop coverage in favor of medicaid is there because you can’t have medicaid with insurance.

  9. Don Levit says:

    What portion of the PPACA discusses reimbursement of providers?
    Just because MA pays its providers that way, how can you logically extend that to the PPACA?
    Don Levit