Insurers in Calif. Health Exchange Limiting Number of Providers

Insurers selling health coverage through California's insurance exchange have limited the number of doctors and hospitals available to policyholders in an effort to lower premiums, according to an analysis of data by the Los Angeles Times (Terhune, Los Angeles Times, 9/14).

Background on Exchange

The ACA's health insurance exchanges -- which primarily will serve individuals and small businesses -- are designed to function similarly to websites like Amazon and Expedia, allowing users to choose among various health plans through an easily navigable online store.

California's exchange -- called Covered California -- is expected to open for registration in October (California Healthline, 9/12).

Details of Analysis

The Times found that narrower provider networks offered through exchange plans could result in policyholders facing:

• Longer wait times for care;
• Fewer specialists; and
• The loss of a long-time doctor.

For example, Health Net will offer the lowest cost coverage options in Southern California, but policyholders who purchase a Health Net exchange plan will have access to less than one-third of the insurer's network of providers for employer-based plans. In addition, Blue Shield of California's exchange plans will include only 50% of the insurer's usual provider network.

Some exchange plans also will exclude certain large hospitals, the Times found. Anthem Blue Cross officials said they are offering the only exchange plans that include UCLA Medical Center and other University of California health facilities.

Reaction

Health care provider groups are concerned that the limited networks will make it more difficult for patients to access care, especially in Latino and African American communities that historically have been underserved, according to the Times.

Experts also say that health care costs could increase in the exchange if patients are unable to regularly visit their doctor and receive necessary follow-up care.

Donald Crane -- CEO of the California Association of Physician Groups -- said the organization is "nervous about these narrow networks," adding, "It was all about price. But at what cost in terms of quality and access?"

The California Medical Association said that the state has underestimated the problems facing policyholders and that the group doubts the state's claim that 80% of California physicians will be included in exchange plans.

State Response

In response to criticisms of limited provider networks in exchange policies, state officials have pressured insurers to include more doctors. Exchange officials say that they will monitor plans and take action if problems become evident.

Peter Lee -- executive director of Covered California -- said, "[I]f a plan can't serve patients, we'll close it down from taking new enrollment."

Exchange officials currently are determining providers' capacity for new patients and offering consumers a way to search for plans that include a specific doctor during enrollment (Los Angeles Times, 9/14).