Here is what the President said at the American Medical Association Meeting in July, 2009––and likely lots more times:
“No matter how we reform health care, we will keep this promise: If you like your doctor, you will keep your doctor. Period. If you like your health care plan, your will keep your health plan. Period. No one will take it away. No matter what. My view is that health care reform should be guided by a simple principle: fix what’s broken and build on what works.”
We have all heard this repeated many times before in recent weeks. But with the front-page story in the Washington Post yesterday, “Health Insurers Limit Choices to Keep Costs Down,” it’s as if somebody rang a new bell this time focused on the “you will keep your doctor” part.
It’s not like we haven’t been talking about more narrow networks becoming a staple of the new health insurance exchanges.
It is as if some of this stuff is just starting to sink in.
Why the limited networks?
In the old health insurance market, insurers competed for business through price and plan design. Network size has historically been a minor factor with consumers and employer plan sponsors expecting to be able to use about any doctor or hospital, especially those with the best reputations.
But with the Affordable Care Act, health plans lost two of their historically big plan pricing variables; medical underwriting and plan design.
Under Obamacare, insurers can no longer underwrite, or exclude people, to keep the cost of their individual market health insurance plans down––a good thing.
Under Obamacare, insurers can no longer offer a wide variety of health insurance products in the individual health market––a good thing when it gets rid of the worst of the health plans out there but not such a good thing when it gets rid of the many policies people could choose and have liked and are now mad about losing. Now, all health plans have to fit into four strict boxes: Bronze, Silver, Gold, and Platinum. And, these boxes can only differ by out-of-pocket costs––not benefits.
So, if a health plan can no longer vary its benefit choices, how can it distinguish itself on price?