More Obamacare Rationing Evidence: Exchange Plans Limit Access Not Only to Top Hospitals and Doctors, But Also to Drugs
By Jennifer Popik, JD, Robert Powell Center for Medical Ethics
As
mainstream media outlets are reporting, and as NRL News Today has
repeatedly documented, tens of thousands who had individual health
insurance policies that were terminated against their will, despite
numerous and repeated assurances from President Obama that if you liked
your insurance plan you could keep it, are finding that the replacement
policies available in the state and federal “exchanges” typically
severely restrict the doctors and health care facilities in their plan
networks. More evidence is emerging of the extent of these limits, and
now there is new information about wide limits on access to lifesaving
drugs.In an article by Ariana Eunjung Cha, the December 9 , 2013, Washington Post reports,
“A new analysis of health plans sold
in the federal exchange — which covers 36 states — and 14 state
exchanges found that the benefits tend to be skimpier than in most other
private insurance in the United States, with drug benefits a particular
weak spot. The analysis, by Avalere Health, a health-care consulting
company, was based on a sample of 600 insurance plans.
. . .
“As the details of the benefits
offered by the new health-care plans become clear, patients with cancer,
multiple sclerosis, rheumatoid arthritis and autoimmune diseases also
are raising concerns, said Marc Boutin, executive vice president of the
National Health Council, a coalition of advocacy groups for the
chronically ill.
. . .
“[P]eople who expected the new plans
to provide pharmaceutical coverage comparable with that of
employer-sponsored plans have been disappointed. . . . [I]nsurers
selling policies on the exchanges have pared their drug benefits
significantly more, according to health advocates, patients and industry
analysts. The plans are curbing their lists of covered drugs and
limiting quantities, requiring prior authorizations and insisting on
‘fail first’ or ‘step therapy’ protocols that compel doctors to
prescribe a certain drug first before moving on to another — even if
it’s not the physician’s and patient’s drug of choice.”
In a December 8, 2013, piece in the highly-regarded British paper Financial Times entitled, “New Affordable Care US health plans will exclude top hospitals,” reporter Stephanie Kirchgaessner writes:
“Amid a drive by insurers to limit
costs, the majority of insurance plans being sold on the new healthcare
exchanges in New York, Texas, and California, for example, will not
offer patients’ access to Memorial Sloan Kettering in Manhattan or MD
Anderson Cancer Center in Houston, two top cancer centres, or
Cedars-Sinai in Los Angeles, one of the top research and teaching
hospitals in the country…. It could become another source of political
controversy for the Obama administration next year, when the plans take
effect. Frustrated consumers could then begin to realise what is not
always evident when buying a product as complicated as healthcare
insurance: that their new plans do not cover many facilities or doctors
‘in network.’ In other words, the facilities and doctors are not among
the list of approved providers in a certain plan.”
And a December 5, 2013, Bloomberg article, “Doc Shock’ On Deck in Obamacare Wars,” Megan McArdle notes
“Come January, when some number of
Americans have bought insurance on the new health exchanges and are
starting to use the services, you can expect another controversy to
arise when many of them find out just how few doctors and hospitals they
have access to…. It’s true that narrowing your networks gives you more
leverage to negotiate prices with doctors — if you’re willing to exclude
most of the doctors in the state, you’re in a better bargaining
position than you are if doctors know that you’re selling customers the
ability to see any doctor they want. But the doctors who are in really
high demand can simply refuse to take the lower price. And
unfortunately, there does seem to be some correlation between how much
we spend on health care and how good the results of treatment are.”
Under the Federal health law, 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.” Not only must the exchanges exclude policies from being offered 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. (See documentation at www.nrlc.org/medethics/healthcarerationing .)
This evidently is creating a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering adequately funded plans that do not drastically limit access to care.
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.
As Kirchgaessner explains,
“Mr. Priselac at Cedars-Sinai in Los
Angeles says … the hospitals that are being excluded are leaders in
innovation, which saves billions of dollars for the healthcare system in
the long run. ‘There is confusion between price and efficiency,’ he
says. ‘The major teaching and research hospitals are more expensive not
because they are inefficient but because of what they do.’”
Source: NRLC News
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