But in this case, leaving out the sparring between providers and insurers meant telling an incomplete story about why the problem exists—and also about why it’ll important to keep close watch on whether this deal holds up, and how powerful these consumer protections really are, as the fighting over networks, payments, and responsibility for disclosure continues. As Bloomberg’s Caroline Chen noted in a fine piece that broadened the New York dilemma to other states, insurers and providers don’t even agree in principle on who should be responsible for providing updated, accurate information to patients about how far their network extends. And there are circumstances that disclosure can’t address. “When someone’s having a heart attack or a baby, you can tell them someone’s not covered, but can they do anything about it,” Georgetown University professor Kevin Lucia told Bloomberg. The fight over how much doctors get paid, and who pays the bill, in a situation like that is just an extension of how expansive insurance networks should be in the first place.
That means reporters should track the details of the final rules that come out of this agreement, and how special interests continue to try to shape the rules of the new game. They should also follow the effort to require insurers to offer out-of-network, benefits perhaps as an option for consumers willing to pay for them. (Earlier this year Crain’s and Namhias and her Capital New York colleague Dan Goldberg reported on this fight.) Cuomo’s deal has eclipsed the broader out-of-network debate for the moment, but it remains central to how the new forces in the healthcare dictate where New Yorkers get their care.
There are big take-aways from the Empire State’s tale. It brings home the contradictions of consumer choice—good when stakeholders want to grow markets and bad when they when they want to restrict it to keep their customers. It also shows what happens when general news outlets that once might have followed such issues through the legislative process don’t do that any more, leaving the job to specialized news outlets like Capital New York and Bloomberg whose elite readers have a big stake in the outcome.
More in The Second OpinionRead More »