This week, HHS released a report praising the healthcare reform law's insurance marketplaces.
The report said individuals who will buy coverage — starting next week — will be able to choose from an average of 53 health plans, and nearly all exchanges feature two or more health insurers.
It paints a nice picture, and indeed, many currently under- and uninsured people will gain access to health coverage that they previously did not have (though it will still likely cost more than $3,000 per year). Additionally, the nonprofit, consumer-directed CO-OPs are a great way to counter the anticompetitive efforts of the bigger, investor-owned health plans.
But I can't help but think the HHS report paints too nice of a picture.
The biggest problem? Access to health coverage means incredibly narrow networks. For example, in Missouri, Anthem Blue Cross and Blue Shield of Missouri is selling plans through the state's marketplace, but it is excluding St. Louis-based BJC HealthCare, which operates 13 highly ranked hospitals. Anthem is conducting similar strategies in Maine and New Hampshire, leaving out several hospitals and providers of its narrow networks but claiming the network will save on costs.
As the New York Times reported last week, all of these "low" health insurance premiums spurred under President Obama's healthcare law are leading to undesirable, highly restrictive provider networks, which limits where a patient can go for care.
Isn't the point of healthcare reform to provide seamless, integrated, patient-centered care from beginning to end, while also making sure people don't go bankrupt from medical costs? Isn't this just another form of ineffective HMOs? Don't get me wrong, HMOs are great for mostly healthy consumers who enjoy the lower deductibles and copays. But HMO plan members know too well that receiving healthcare comes at the expense of only going to network providers.
Just compare the more open Medicare to its private HMO counterpart, Medicare Advantage. Beneficiaries enrolled in Medicare generally love their health plans because Medicare is reliable, and beneficiaries can see their hospital or doctor of choice. MA beneficiaries? Well, they are mostly cherry-picked by the private health insurers, meaning the healthiest among the elderly buy the plans, and they are often reduced to those same narrow networks. (Not to mention, MA health insurers are incredibly overpaid.)
While some care is better than none, the exchanges really don't go far enough, at least not yet. It's great to see President Obama's law providing an outlet for people to start obtaining somewhat affordable health insurance, but is the restriction of provider choice a worthy trade-off? And that's part of the problem — there shouldn't be a trade-off. A lot remains to be seen with the exchanges, and I wonder what a public option could've provided if it were part of the law.