The Obama administration is seeking to address one of the two central complaints from consumers about insurance plans offered through the Patient Protection and Affordable Care Act marketplace by implementing new rating measures that will reward insurers that offer beneficiaries access to many providers in their area.
The administration will not mandate broader networks, but it will seek to make it clear to consumers shopping for plans on HealthCare.gov that some some include more providers than others. Each plan will have a label that indicates how broad the network is.
Consumers in some areas have said that their health plans are so narrow that they can’t find primary care physicians, specialists or even hospitals nearby that are covered.
The narrow networks not only force people to travel long distances to find an in-network provider, but they have in many instances appeared to drive people who can’t find in-network physicians to the emergency room. In November, the American College of Emergency Room Physicians reported high numbers of insured patients seeking care for non-emergency conditions in the ER. The group urged the administration to demand broader networks from insurers, for the sake of both patients and providers.
The problem is, some consumers like narrow networks. They tend to be cheaper. So as the administration seeks to incentivize broader networks, it risks raising costs for many consumers who would prefer a bare-bones policy with the lowest premiums possible.
In fact, the same day the administration announced the network measures, it also announced that it would be raising by $250 the limit on out-of-pocket costs for plans, to $7,150 for an individual and $14,300 for a family.
The administration has said that the increases are simply in keeping with a schedule of increases laid out in the PPACA. The limit will increase by $300 next year, though.
Sabrina Corlette, a Georgetown professor of public health, told the New York Times that “the administration was walking a very delicate line, pushing forward with consumer protections while trying to keep insurers onboard and participating in the marketplaces.”
In recent weeks the administration has unveiled other measures aimed at addressing concerns that insurers voiced about their ability to turn a profit in the marketplace.
Most notably, the administration has limited the number of exemptions it will grant for those who try to enroll in plans past the open enrollment deadline. Those who seek to enroll past the deadline will also be subject to stricter documentation requirements to prove they qualify.
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