Obamacare: Fewer options for many

Consumers should check with doctors to see if they accept marketplace plans

CNN News Wire | 10/29/2013, 12:57 p.m.
Some of Thomas Harte’s New Hampshire neighbors are frustrated by the Affordable Care Act’s insurance marketplaces but not for the ...

The hospital, he wrote, would be “paid less than what it costs us to provide care,” and said his advisers told him the facility should be cautious about “committing to rates that could be detrimental to one’s organization.”

Concord is not the only New Hampshire city with a limited network of providers. Portsmouth’s hospital isn’t taking the insurance either. And only one of the two major hospitals in Nashua is in-network, according to Harte.

“That’s a big frustration to my clients who heard their President promise that if you like your doctor you can keep them,” Harte said. “Sure, you can keep them if you pay cash for their services. But if you want your new insurance to cover that doctor visit, forget it. You’re going to have to switch.”

In selling his health care plan to the nation, President Barack Obama did offer a “guarantee” that “if you’ve got a doctor that you like, you will be able to keep your doctor.”

The HealthCare.gov site is more specific in its section “Can I keep my own doctor?” It explains, “Depending on the plan you choose in the Marketplace, you may be able to keep your current doctor. Different plans have different networks and providers.”

“May,” of course, differs from a “guarantee.”

“Across the board, the networks and the PPOs (preferred provider organizations) are significantly narrower than people are used to,” said Michael Weinberg, a senior policy adviser dealing with health policies for California’s Bay Area Council, a business-sponsored public policy advocacy group.

“Narrower networks is one way to keep costs (of these policies) down. Some of the networks may be too thin, at least for now anyway.”

Provisions in the health care reform law say there has to be an adequate number of providers offered in these insurance networks.

“It still remains to be seen if that happens,” said Davis of John Hopkins. “In principle, you couldn’t exclude all obstetricians, for instance. That plan would not be considered adequate.”

As the marketplaces are around longer, more providers may opt into the system, according to Dr. Susan Turney, head of the Medical Group Management Association, a trade group that represents multiple physician medical practices.

The group’s survey of its members in September found that more than 40% were still deciding if they were going to accept the insurance offered through the ACA marketplaces.

“Many of the practices are still struggling to know what it means for them,” Turney said. The association suggests that people who already have a doctor call to see if they will accept a particular policy. “We know a number of our members have trained their staff to answer those kinds of questions.”

If someone doesn’t have a doctor, online resources can help with selecting one.

While providers are limited with these plans, in the long run Davis said she believes “it’s actually a good thing to reward higher quality, lower cost providers” as that could ultimately cut the cost of health care as the reform legislation intended.

Jen Christensen | CNN