Bottom line: Insurers are worried that continued high prices will hurt business, so they need to find ways to lower the prices, and narrowing their networks is the ticket. Indeed, Abelson reports that insurers will be able to reduce their premiums by offering more restrictive plans. Dr. Sam Ho, the chief medical officer for United Healthcare, says that more employers are interested in limited arrangements for their workers “because, quite frankly, affordability is the most pressing agenda item.”
Choice—-or at least choice that will not cost you—is likely to be increasingly scarce as health insurers and employers scramble to find ways of keeping premiums from becoming unaffordable.
Carriers are experimenting with different ways to force consumers into the restricted networks. Ho’s operation is trying out plans where patients can see a doctor not in the network, but they will have to pay much higher out-of-pocket costs than they would in a traditional plan with out-of-network benefits. Aetna is testing a narrow network in New York that has half the doctors and two-thirds of the hospitals it typically offers. Those who enroll are covered only if they use in-network providers. Ouch, if the best brain surgeon you need is not among them.
Déjà vu time, guys! This is the very industry that tried to force consumers into restricted managed care organizations during the 1990s, only to loosen up when consumers and doctors fought back. Who knows if consumers will rebel again? And what about the docs who will be left out—those who signed on to reform because they were promised a ton of new patients?
Insurers are testing the waters in advance of all those new customers who will dive in come 2014, when the insurance exchanges and government subsidies kick in. Skimpy policies with their limited networks may be the only way customers can afford the required insurance. That, of course, leaves them vulnerable when serious illness strikes. And that brings up the problem of underinsurance, which reform was supposed to correct. Then, too, there’s the issue of continuity and coordination of care we heard reformers preach last year. If you get jerked around by your insurer, and must find new providers in the network to protect your pocket book, it’s hard to see how there will be much continuity and so-called “quality” care.
Did the Times reporters stumble onto unintended consequences of reform, or did they discover a hard truth—that it’s damn tough to regulate American business? Whichever it is, we hope they and their colleagues at other news outlets will keep calling out these contradictions.