Almost Half of Health Law Plans Offer Very Limited Physician Networks

Published August 17, 2015

Obamacare health insurance plans limit consumers’ access to physicians and specialists, according to a new report.

Avalere Health, a strategic advisory firm, says average provider networks for plans offered on the health insurance exchanges created by Obamacare have about 34 percent fewer providers than the average commercial plan offered outside the exchange. The new data quantify anecdotal reports saying exchange networks include fewer providers than traditional commercial plans.

According to the report, exchange plan networks have 42 percent fewer oncology and cardiology specialists, 32 percent fewer mental health and primary care providers, and 24 percent fewer hospitals.

Care provided by out-of-network providers does not count toward the out-of-pocket limits put in place by Obamacare.

Limitations Obscured

Consumers are more likely to select a plan with lower premiums but are unaware of the lack of physicians that will be available for them when they need treatment, says John Graham, a senior fellow at the National Center for Policy Analysis.

“There is a fundamental conflict of interest between the Obamacare beneficiary and the Obamacare health plan,” Graham said. “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.”

Young or old, healthy patients have less incentive to explore the minutest details of their plans when they initially sign up, but the plans’ shortcomings could really hurt them in the long run, says Graham.

“The main problem is it is impossible for the ordinary consumer to figure out he is in a narrow network, so he cannot make an informed choice,” Graham said.

Cost-Control Measure

The bottom line, says Dr. Roger Stark, a health care policy analyst at the Washington Policy Center and a retired physician, is insurance carriers can’t compete meaningfully on plan design because of the benefit mandates in Obamacare. Price is the main area of competition.

To create price competition and hold down the premium costs for plans in the exchanges, insurance companies have resorted to limiting provider networks in their plans, Stark says. Carriers are negotiating more favorable contracts with fewer doctors and hospitals and limiting the number of specialists in their networks.

“One of the classic examples was out here in the Puget Sound area [in Washington State],” Stark said. “Originally, the largest carriers in the Washington exchange did not include Seattle Children’s Hospital, the largest pediatric facility in the Northwest. Contracts were ultimately renegotiated after a lot of bad press.”

Inherent Limitations

The thinness of these plans shows the inherent limitations of government-run medicine, says Dr. John Dale Dunn, an emergency physician in Brownwood, Texas.

“Socialism is not concerned with quality and access, but it is concerned with price sensitivity,” Dunn said. “In a socialist system, the end result will always be mediocre service and price controls,” Dunn said.

Kaitlyn Clancy ([email protected]) writes from Chicago, Illinois .

Internet Info

Avalere Health, “Exchange Plans Include 34 Percent Fewer Providers than the Average for Commercial Plans,” July 15, 2015: