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.”
Abelson reports:
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.
Just a typo alert: "that tow the financial line insurers draw in the sand"
Tow s/b toe.
#1 Posted by Mollie, CJR on Wed 28 Jul 2010 at 03:59 PM
MA residents know all about underinsurance, no choice of decent docs, losing continuum of care, paying penalties, feeling oppressed on a daily basis and more under the MA plan which is the model for Obamacare. We tried to warn people about all of this including the lack of "robust" exemptions which Obama also touted and much more that will leave most Americans worse off than they already are.
Trudy's series on the MA plan covers quite a lot of the MA mess wonderfully well and should be read by all for a glimpse into the near future under Obamacare. For the ugly details about exemptions/appeals/sharing your personal info/estate recovery and such, visit http://www.masshealthlawtruth.org before August 8.
Things in MA have gotten even worse as insurance premiums continue to rise, use of certain hospitals has been removed from many plans per an agreement by MA Gov. Deval Patrick with the insurers under the disguise of "getting them to cap their rates." (It's an election year for Patrick so he needs to look like he's doing something but doesn't tell the entire story which is par for the course with most politicians.) E.R. use has also increased while seven safety-net hospitals have sued the state over reimbursements.
Once people figure out how this works, they will be scrambling to figure out ways to duck for cover such as intentionally lowering their incomes to have cheaper penalties b/c the cheapest subsidized plan will be too expensive and so crappy that they won't be able to use it. And if they become seriously ill, they will go bankrupt. This type of set-up leaves people with no other choice. It is regressive. The politicians know this but don't care.
People will be shocked when they find out how this really works and what was done to them by their public servants. It is oppressive and does not provide access to affordable, comprehensive, quality health care. However, it is important to note that neither the MA plan or Obamacare were designed to do this.
btw, I have some questions for Doc Berman, Obama's recess appointment to head up CMS who champions rationing care:
1. What's the cut-off age?
2. Do those whose care is rationed get a discount on their premiums?
3. Who appointed you God?
(Answer to #3: Obama)
#2 Posted by dianne, CJR on Fri 30 Jul 2010 at 01:34 AM
In April 2010, Morgan Stanley/Smith Barney installed a $35 per quarter fee for "low balance households." (An investor with less than $25,000) This is outrageous considering that I've owned these two preferred stocks since 2001 (not much under $25,000), and there were no fees. Taxpayers just bailed these creeps out and they want more!
Methinks Morgan Stanley just wants some extra money to increase the CEO bonuses. The $35 is a hit on the quarterly dividend checks which many need to supplement income along with the less than adequate amount of work that is available and/or modest Social Security income.
Why did Morgan Stanley do this? Because it can. The same way the health insurance companies will steadily increase premiums under Obamacare which has no cost containment. When health insurance becomes compulsory nationwide as it has been for the past four years in Massachusetts where premiums are the highest in the country and still climbing, there is no incentive for the insurers or pharma to keep the costs low! The excuses are already starting with these leeches as we who are following this sad saga know.
I called Barney Frank's office about the Morgan Stanley new fees thinking that this would be of interest to him since Congress was working on "financial reform to reign in Wall St. and help We the People" but was told that these companies can do business as they wish.
Frank, Kerry, Schmerry and all the other yahoos in Washington could care less about what we are subjected to as long as their money-masters on Wall Street (and in the medical industrial complex as we have seen with the faux health care reform) are happy, and the big bucks are being stuffed into the pols' campaign coffers.
What's next? Will they take what's left of our retirement savings and use it shore up Social Security? I don't doubt for a minute that they would do this along with the other "plans" of the deficit commission such as cutting Social Security, Medicare and Medicaid, putting in a 20 percent VAT tax and so on.
It's all part and parcel of the big plan - back to serfdom we go to pay off the deficit they created with their useless, ongoing, illegal wars while the kings and queens live high on the hog!
#3 Posted by disgusted citizen, CJR on Sat 31 Jul 2010 at 02:34 AM