Maybe they will; maybe they won’t. That depends on what steps the exchange is taking to make sure there are sufficient doctors and hospitals for the newly insured. If people find their doctors are not in the plan, or a hospital covered by the plan is too far away, they won’t buy a policy, and that, too, can affect the mix of the risk pool.
And there’s the fear that insurers will omit providers in certain areas where there are clusters of patients with diseases they’d rather not insure. New York’s experience with AIDS is an example. In a fight with insurers over the availability of an out-of-network rider for insurance coverage, the Center for the Independence of the Disabled found that many HIV specialists were not in any provider networks. Matching up provider networks with diseases common to certain populations is a good enterprise project for an eager reporter.
Will the exchanges become like Medicaid? That is, will some doctors refuse to take patients with exchange coverage, because insurers selling through the exchanges offer lower reimbursement? This question zooms right in on the insurers’ fears that only sick people will buy coverage. Lower reimbursements might be one way they could cope with the high costs of insuring the sick, but if providers balk, people could have a problem. (Remember, insurers can no longer refuse coverage to those who are sick and need to make up their losses somehow.)
Key Question: What is your exchange doing to insure network adequacy?
How will the exchange sell its policies?
The trick, says one exchange expert, is “how to convince people to enroll in this unaffordable thing.” The answer, of course, depends on the outreach and the sales job. When Massachusetts beefed up promotion of its pioneer exchange, called The Connector, it bombarded fans at Red Sox games with advertising aimed at getting young men to sign up for insurance. It worked. But the Bay State has a culture of insurance. Whether the Illinois exchange will have similar success with White Sox fans or whether the Mississippi exchange hawking insurance at Ole Miss football games will reel in the sales is not known.
Some exchanges, like Connecticut’s, have gone out to listen to the people who will soon be their customers. Given the fact that the Kaiser Family Foundation just found that two-thirds of the uninsured population and more than half of the entire population don’t understand how the health reform law will impact them, such listening tours seem essential.
Obamacare provides for helpers—called “navigators”—to help people enroll in coverage through the exchanges. It also providers for “assisters” to aid people who need additional help. (Assisters are supposed to have training and meet conflict-of-interest guidelines.) Whether these new helpers will do a better job than some of the counselors at state health insurance programs (SHIP) for Medicare beneficiaries remains to be seen. I have found SHIP counselors who were outstanding and some who were very unhelpful. If there are too many of the latter, people may not sign up. All this means the press needs to keep tabs on them, perhaps by sitting in on counseling sessions with consumers seeking insurance in the exchanges, or finding a candidate for coverage and observing what he or she goes through to get insurance.
Key Question: How serious is your exchange about outreach and education?
The Kaiser poll out last week came with a warning: Americans’ expectations of how the law will affect healthcare costs, quality, and consumer protections are more negative than positive, and often off-base. False information still pervades peoples’ thinking. Fifty-seven percent of the public believes the health law includes a public option. Almost half think it gives illegal immigrants money to buy insurance. And 40 percent still thinks that death panels will make decisions about end-of-life care for Medicare seniors.
We have our work cut out for us.
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