In California access to top docs and hospitals dwindles under Obamacare

October 8, 2014 09:00 AM

By Jennifer Popik

Californians with health insurance obtained through the Obamacare exchange are continuing to find themselves being turned away when they seek out many top health care specialists and hospitals, according to the latest report in an ongoing investigation by the Los Angeles Times.

The Obama Health Care Exchange (called Covered California within the state) has the power to exclude insurance plans in the exchange based on rate increases. The problem is the plans often need to raise rates to ensure access to high-level life-saving care. Because plans are worried about being booted from doing business in the state exchanges, they have slashed costs by dramatically reducing access to highly effective—and therefore more expensive—doctors and medical centers.

In a September 28, 2014, piece, “Obamacare doctor networks to stay limited in 2015,″ reporters Chad Terhune, Sandra Poindexter, [and] Doug Smith chronicle the result: “The state’s largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data.”

Narrow networks are one way insurers are attempting to keep premiums unrealistically low.

Another way people are being denied access is through pushing insurance plans that normally only allow the use of in-network providers—what most people used to call “closed-panel Health Maintenance Organizations (HMOs)” (although their label has now changed).

In addition to shedding doctors, California’s biggest insurers have promoted more restrictive policies known as EPO, or exclusive-provider organization, plans. Unlike a more generous PPO (Preferred Provider Organization), an EPO typically does not provide any coverage for out-of-network providers. Consumers would be responsible for the full charges if they left their network.

California officials seem pleased with the reduction in health care access despite rampant consumer complaints, because it means less money devoted to saving lives and preserving health. From the LA Times piece:

Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms, said . . . “It’s been a low priority for insurance companies to maintain these provider directories, and states really aren’t pushing back on narrow networks. . . . ”

“Covered California endorses the industry’s narrow network strategy as a way to keep premiums affordable. The state has credited it for helping produce two straight years of lower-than-expected premiums for individual coverage. Rates for 2015 are expected to increase 4.2 percent, on average.”

While many are quick to blame profit-driven insurers, the real culprit is likely the Obamacare provision under which exchange bureaucrats must exclude insurers who offer policies deemed to allow “excessive or unjustified” health care spending by their policyholders. Insurers are quoted as having their eye on managing rates hikes—despite the fact that these rate hikes are often necessary to maintain access to the best docs and hospitals.

The LA Times article explained: “Health Net has proposed the most dramatic change for 2015, the data show. It’s dumping the PPO network . . . and switching to a plan with 54 percent fewer doctors and no out-of-network coverage, state data show. . . . Health Net said its cutbacks were necessary to avoid even steeper rate hikes and it’s confident the smaller network will be sufficient.”

Under the federal health law (Obamacare), state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers . . . based on a pattern or practice of excessive or unjustified premium increases.” The exchanges not only exclude policies in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount.

Under Obama administration regulations, any plan with a year-to-year premium increase exceeding 10 percent is to be treated as suspect.

This means that insurers who hope to be able to gain customers within the exchanges have a strong disincentive to offer any adequately funded plans that do not drastically limit access to care. So even if you contact insurers directly, outside the exchange, you are likely to find it hard or impossible to find an adequate individual plan. (See documentation at www.nrlc.org/medethics/healthcarerationing.)

When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less—or nothing—for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.

Many experts predict that when the exchanges are opened to employees of all businesses in 2017, many employers will end their present coverage and force their workers into the constricted exchange plans. Just as most businesses have gradually moved away from “defined benefit” pension plans under which retirees were guaranteed a certain income, replacing them with “defined contribution” programs under which employees must instead rely on their own contributions to their 401(k) retirement plans while receiving some matching contributions from employers, experts predict most businesses will stop offering their employees health insurance directly, instead providing them a lump sum they can use toward the cost of exchange health plans.

So the dramatic cutbacks in access to those specialists and medical centers that provide expensive care for hard-to-treat, challenging illnesses and injuries are likely to spread beyond the health plans for individuals and small businesses now most directly affected to include the insurance plans covering almost all Americans.

“As more and more insurers exclude top-level medical centers like Johns Hopkins, M.D. Anderson, and UCLA Medical Center, such go-to facilities for advanced care will have no economic option but to shrink to shells of their current capacities,” says Burke Balch, JD, director of National Right to Life’s Powell Center for Medical Ethics.

Balch warns, “If Obamacare’s rationing proceeds unabated, within five to ten years we can expect most of America’s top-rated specialists either to retire or to move overseas to locales like the Cayman Islands, Singapore, and Malaysia, which are already attempting to assume the leadership role in cutting-edge medicine once held by the United States. Unless changes in Congress and the Presidency make possible the adoption of Senator Pat Roberts’ (R-KS) ‘Repeal Rationing in Support of Life Act’ or similar legislation, the time may not be too distant when Americans needing advanced medical care had better have their passports—and their bank accounts—ready.”

Jennifer Popik, J.D., serves as legislative counsel of the National Right to Life Committee’s Robert Powell Center for Medical Ethics, which deals with euthanasia-related issues including assisted suicide; denial of lifesaving medical treatment, food, and fluids; and healthcare rationing. She lobbies Congress on end-of-life issues and euthanasia and assists in a variety of related legal issues. She also serves as counsel for the Department of State Legislation, assisting state affiliates with drafting pro-life legislation and providing any additional needed legal support. She received her law degree from Cleveland Marshall College of Law. She has four children—including twins with special needs.

This article has been reprinted with permission and can be found at http://www.nationalrighttolifenews.org/news/2014/10/in-california-access-to-top-docs-and-hospitals-dwindles-under-obamacare/#.VDVm_fldWSo

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