The return of “narrow networks.” The Kansas City Star’s Alan Bavley and Diane Stafford cast a critical eye on the policies offered by insurance companies in their region on the new exchange, focusing in particular on which of the area’s providers were in or out of network. Blue Cross and Blue Shield of Kansas City is selling versions of many plans with just seven hospitals in its network, rather than the 19 hospitals the carrier typically includes. Coventry, the only other seller in the area, has eliminated the St. Luke system but includes others. The reporters offered good context for readers to understand the trade-off between cheaper premiums for bronze and silver plans and the limited provider choices those plans offer, along with a debate among wonks and professionals about the costs and benefits of different approaches. One point often missed in the limited coverage of the narrow network issue is that narrow networks have been tried before, when HMOs became dominant in the 1990s. Back to the future, perhaps?
Sticker shock—for some. Tracy Seipel of the San Jose Mercury News examined another aspect of the new landscape—insurers are beginning to cancel individual market policies not grandfathered under the law. That means cancellation letters advising of higher prices for new insurance are in the mail, as Bay Area residents Cindy Vinson and Tom Waschura discovered. They told the paper they are big believers in the Affordable Care Act but “were floored last week when they opened their bills.” If they choose to enroll in the policies offered by their insurers, Vinson will pay $1,800 more a year for an individual plan, while Waschura will pay nearly $10,000 more for coverage for a family of four. The reasons: the new minimum benefits that policies must offer, plus annual medical inflation costs that companies would pass along with or without Obamacare. Health insurance expenses are also especially high in the Bay Area, in part because of reduced competition among hospitals. Then there’s the fact that the law is designed to reduce costs for sicker and lower-income consumers—a group that doesn’t include Vinson or Waschura, neither of whom quality for subsidies in the California exchange because their incomes are too high. Said Waschura:
“I really don’t like the Republican tactics, but at least now I can understand why they are so pissed about this. When you take $10,000 out of my family’s pocket each year, that’s otherwise disposable income or retirement savings that will not be going into our local economy.”
In its focus on the law’s impact on upper-middle-class households, the Mercury News article has some overlap with a Fox News segment we dinged last week—but done with much more balance and context. Whether there will be backlash from other relatively high-income folks—and how they respond—will be a story to watch.
Opening shots for 2014. If you doubt that Obamacare will be an election year issue again in 2014, check out a report this week from the Omaha World-Herald. Well-funded political newcomer Ben Sasse is one of four Republicans vying for a Senate seat being vacated by Mike Johanns, and the paper reported that at his official kick-off event, Sasse delivered this line about the Affordable Care Act: “If it lives, America as we know it will die. If the idea of America is to live, it must be stopped.” How exactly the country would “die” from a healthcare reform measure wasn’t pinned down in the story, though Sasse did say the law created a “dependency culture” and “insinuates” government into every aspect of American life.
Reporters covering politicians who offer this sort of rhetoric might want to ask them to grapple with a point made recently by Avik Roy in the conservative flagship National Review: long before Obamacare was passed, the government was pretty thoroughly “insinuated” into healthcare policy.
The World-Herald article did note that Sasse pledged to talk more about “patient-centered health policy solutions” to replace Obamacare. If he proves to be a serious candidate, we hope the paper holds him to this promise—and carefully probes this rhetoric.