Some of Thomas Harte’s New Hampshire neighbors are frustrated by the Affordable Care Act’s insurance marketplaces but not for the reasons you might expect.
Harte is an insurance broker. He still has his share of frustrations with the marketplace websites, but the growing number of complaints he hears come from clients and fellow brokers who have seen the policies these marketplaces offer.
Nationally the marketplaces offer tens of thousands of different policies with a wide variety of coverage, but Harte has noticed many have one thing in common: They cover a narrow network of doctors and hospitals.
That narrower network comes as particularly bad news for the residents of Concord, New Hampshire.
Concord’s one hospital won’t accept any policies offered by the marketplaces. To see a doctor, specialist or primary care provider affiliated with the hospital, patients on these Obamacare plans will have to pay out of their own pocket. The closest in-network hospital is in Manchester.
“Can you imagine having to go 25 miles away to Manchester to get access to a health care provider that is covered by your insurance?” Harte asked. “Right now, Concord is one big black hole of health care for people buying these plans.”
And it’s not just Concord. Nationally, consumers are learning a number of well-known hospitals won’t accept insurance offered through the marketplaces.
In New York, NYU will accept only a minority of the plans. In Los Angeles, UCLA medical centers will accept a couple. In Atlanta, Emory has limited the number of plans it will take. Academic medical centers are often pricier because they tackle the more complex cases.
WellPoint, a Blue Cross Blue Shield insurer offering policies in 14 states, is narrowing its networks in many markets after research showed consumers care more about the price than the provider.
A survey done by PriceWaterhouse Cooper found that 43% of those surveyed considered the cost of the policy the most important factor when they pick a health insurance plan.
But the picture isn’t all bleak.
“Some coverage is better than no coverage,” said Karen Davis, an economist and professor of health policy at Johns Hopkins University.
Davis gives the ACA marketplaces high marks overall since it is a lot easier to compare plans in these marketplaces than when consumers were buying insurance on their own. With the standardized essential benefits offered by all plans, “you can be a little bit more assured that Plan A and Plan B will provide decent coverage.”
“We’re going to get better benefits in this market,” said Jonathan Gruber, an economist at MIT who was an architect on both the Massachusetts and U.S. health plans.
“Right now, in this insurance market, not only is it discriminatory, but the typical person with an individual-payer plan has a very weak insurance plan. ... It’s not real insurance. We’re going to get rid of that—everyone will have guaranteed, real insurance.”
In the case of Concord Hospital, the CEO and president wrote a letter to the local newspaper explaining that his hospital wasn’t opting out of Obamacare as a “political statement.” Instead, Michael B. Green blamed Anthem Blue Cross Blue Shield, the state exchange’s only provider, for being “unwilling to negotiate sustainable contract terms.”