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Tags: health care exchanges | obamacare
OPINION

Obama's Exchange Scam Doesn't Grant Healthcare Access

a road sign reading health insurance changes ahead against a blue sky with puffy white clouds
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Sally Pipes By Tuesday, 18 April 2023 12:10 PM EDT Current | Bio | Archive

The Biden administration has devoted billions of taxpayer dollars to boosting enrollment on Obamacare's health insurance exchanges — mostly by paying people to sign up, in the form of enhanced premium subsidies.

So it's no surprise that the 2023 open enrollment period broke records, with 16 million Americans securing coverage through the exchanges.

But those 16 million people may be saddled with coverage that is effectively useless. That's because most exchange plans confine people to narrow provider networks. Enrollees may have an insurance card — but may not be able to find a doctor or hospital who will take it.

Last August, the Government Accountability Office found that 243 of 375 insurers examined by the Centers for Medicare and Medicaid Services didn't meet network adequacy standards for plan year 2023.

And that figure might actually understate the scope of the problem. That's because the adequacy of a network is usually determined by looking at directory data from plan providers. And these directories are often inaccurate.

Indeed, narrow networks have been endemic to exchange coverage since the marketplaces opened in 2014, nearly four years after Obamacare was signed into law in 2010. Nearly three-quarters of marketplace coverage for the 2019 plan year featured narrow provider networks, an analysis from the consulting firm Avalere Health found.

A 2020 study published in the journal JAMA Network Open found that narrow networks are a much bigger problem for marketplace plans than for large-group employer plans.

The upshot is that patients with exchange coverage may struggle to find a physician who will accept their insurance — or to get an appointment with one of the few docs that is in-network. Some people may need to travel long distances to seek treatment. Others may need to pay out of pocket or forgo care completely.

Obamacare itself is largely to blame for all these barriers. After all, the law forced insurers to abide by a number of cost-inflating regulations.

They must sell to all comers, regardless of health status or history, and cannot charge older people any more than three times what they charge the young. They must also cover 10 essential health benefits and a number of preventive services at no cost to beneficiaries.

That leaves insurers with few strategies for keeping costs under control. Narrow networks are among them. By promising to funnel all their beneficiaries to a limited number of providers, insurers can insist on paying lower rates. They can also cut out higher-priced — and possibly better-quality — providers from their networks.

Insurers aren't just limiting which providers their beneficiaries can see. They're forcing them to cover a greater share of the cost, too. This year, the average medical and prescription drug deductible for a Bronze-level plan was nearly $7,500. That's up from $5,100 in 2014.

So an individual insured with an average Bronze plan would have to pay nearly $7,500 out of their own pocket before their medical coverage kicks in. His premiums, assuming he has the average lowest-cost bronze plan, are another $342 a month. So he's looking at well over $11,000 in healthcare spending each year before he sees a dime from his insurance company. And that's if he can find an in-network doctor who will see him.

And yet Democrats have the temerity to criticize the short-term health plans available off the exchanges as "junk insurance." Nevermind that many short-term plans offer coverage that's as comprehensive as exchange coverage, with broader provider networks at a lower price.

The Biden administration may be cheering Obamacare's record-high enrollment numbers. But patients are increasingly finding that their exchange coverage doesn't actually grant them access to care.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is "False Premise, False Promise: The Disastrous Reality of Medicare for All," (Encounter Books 2020). Follow her on Twitter @sallypipes. Read Sally Pipes' Reports — More Here.

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SallyPipes
The Biden administration may be cheering Obamacare's record-high enrollment numbers. But patients are increasingly finding that their exchange coverage doesn't actually grant them access to care.
health care exchanges, obamacare
652
2023-10-18
Tuesday, 18 April 2023 12:10 PM
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