There is so much controversy about the ACA these days (and for many days leading up to now) that the impact on average people is getting lost. Everyone wants to argue their “position,” but very few of the people arguing are actually impacted by the law.
I don’t know a single person on either side of the issue who would argue that they don’t want people to have access to healthcare. But carrying an insurance card in your wallet doesn’t guarantee access.
Although it is in its early days, we are starting to see a pattern emerge that should concern us all. In order to keep costs down, many insurance plans do two things:
- Severely limit the number of physicians in a given network
- Deny in-network access to top hospitals (especially in specialty fields such as cancer). For example, Memorial Sloan Kettering currently accepts three ACA providers from NY and one from NJ. In other words, not a lot of providers.
When all of these issues were being debated, one of the criticisms leveled at the plan was that HC would be rationed. Proponents of the plan said that wasn’t so, and when the final language of the bill came out, they supported their position by saying that there was no reference to rationing in it (although, honestly, did anybody read the whole thing?). Yet very small provider networks represent defacto rationing. If you call your doctor and he/she can’t see you for three weeks because all of the appointments are booked, your access to care is restricted. For most of the previously insured, this will come as a shock period. For both insured and uninsured alike, reduced access to general practitioners will likely translate into ER visits. Of course there is not enough data to evaluate this yet, but it’s a risk. It is also worth noting that ER usage (and the increased costs associated with it) is something that the ACA is supposed to decrease.
What we are seeing, which is something that nobody brought up for debate, is that less expensive plans offer fewer in-network providers. It stands to reason that very few people will be able to afford platinum or gold plans. This means that many of us will become part of the networks formed under silver and bronze plans. It is in these plans that network breadth, and therefore, access, is most compromised.
Similarly, before choosing a plan, evaluate the hospitals that accept it. We are seeing a lot of information about how top medical centers are opting out or being excluded from many networks. While routine care may be best performed at a local facility, if you or a loved one becomes seriously ill, access to top centers can mean the difference between life and death.
Access, there’s that word again.