NRL News

More Obamacare Rationing Evidence: Exchange Plans Limit Access Not Only to Top Hospitals and Doctors, But Also to Drugs

by | Dec 11, 2013


By Jennifer Popik, JD, Robert Powell Center for Medical Ethics

DocShockAs mainstream media outlets are reporting, and as NRL News Today has repeatedly documented, tens of thousands who had individual health insurance policies that were terminated against their will, despite numerous and repeated assurances from President Obama that if you liked your insurance plan you could keep it, are finding that the replacement policies available in the state and federal “exchanges” typically severely restrict the doctors and health care facilities in their plan networks. More evidence is emerging of the extent of these limits, and now there is new information about wide limits on access to lifesaving drugs.

In an article by Ariana Eunjung Cha, the December 9 , 2013, Washington Post reports,

“A new analysis of health plans sold in the federal exchange — which covers 36 states — and 14 state exchanges found that the benefits tend to be skimpier than in most other private insurance in the United States, with drug benefits a particular weak spot. The analysis, by Avalere Health, a health-care consulting company, was based on a sample of 600 insurance plans.

. . .

“As the details of the benefits offered by the new health-care plans become clear, patients with cancer, multiple sclerosis, rheumatoid arthritis and autoimmune diseases also are raising concerns, said Marc Boutin, executive vice president of the National Health Council, a coalition of advocacy groups for the chronically ill.

. . .

“[P]eople who expected the new plans to provide pharmaceutical coverage comparable with that of employer-sponsored plans have been disappointed. . . . [I]nsurers selling policies on the exchanges have pared their drug benefits significantly more, according to health advocates, patients and industry analysts. The plans are curbing their lists of covered drugs and limiting quantities, requiring prior authorizations and insisting on ‘fail first’ or ‘step therapy’ protocols that compel doctors to prescribe a certain drug first before moving on to another — even if it’s not the physician’s and patient’s drug of choice.”

Besides limits on access to drugs, there are more news accounts on limits on access to hospitals and doctors.

In a December 8, 2013, piece in the highly-regarded British paper Financial Times entitled, “New Affordable Care US health plans will exclude top hospitals,” reporter Stephanie Kirchgaessner writes:

“Amid a drive by insurers to limit costs, the majority of insurance plans being sold on the new healthcare exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centres, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country…. It could become another source of political controversy for the Obama administration next year, when the plans take effect. Frustrated consumers could then begin to realise what is not always evident when buying a product as complicated as healthcare insurance: that their new plans do not cover many facilities or doctors ‘in network.’ In other words, the facilities and doctors are not among the list of approved providers in a certain plan.”

And a December 5, 2013, Bloomberg article, “Doc Shock’ On Deck in Obamacare Wars,” Megan McArdle notes

“Come January, when some number of Americans have bought insurance on the new health exchanges and are starting to use the services, you can expect another controversy to arise when many of them find out just how few doctors and hospitals they have access to…. It’s true that narrowing your networks gives you more leverage to negotiate prices with doctors — if you’re willing to exclude most of the doctors in the state, you’re in a better bargaining position than you are if doctors know that you’re selling customers the ability to see any doctor they want. But the doctors who are in really high demand can simply refuse to take the lower price. And unfortunately, there does seem to be some correlation between how much we spend on health care and how good the results of treatment are.”

While some are blaming the insurers, the true culprit is the Obamacare requirement that exchange bureaucrats exclude insurers who offer policies deemed to permit Americans to engage in “excessive or unjustified” health care spending. As the Post article reports, “Insurers . . . acknowledge that to keep premiums low, they must restrict the use of some costly drugs if there are alternatives.”

Under the Federal health law, state insurance commissioners are to recommend to their state exchanges the exclusion of “particular health insurance issuers … based on a pattern or practice of excessive or unjustified premium increases.” Not only must the exchanges exclude policies from being offered in an exchange when government authorities do not agree with their premiums, but the exchanges must even exclude insurers whose plans outside the exchange offer consumers the ability to reduce the danger of treatment denial by paying what those government authorities consider an “excessive or unjustified” amount. (See documentation at .)

This evidently is creating a “chilling effect,” deterring insurers who hope to be able to compete within the exchanges from offering adequately funded plans that do not drastically limit access to care.

When the government limits what can be charged for health insurance, it restricts what people are allowed to pay for medical treatment. While everyone would prefer to pay less–or nothing–for health care (or anything else), government price controls prevent access to lifesaving medical treatment that costs more to supply than the prices set by the government.

As Kirchgaessner explains,

“Mr. Priselac at Cedars-Sinai in Los Angeles says … the hospitals that are being excluded are leaders in innovation, which saves billions of dollars for the healthcare system in the long run. ‘There is confusion between price and efficiency,’ he says. ‘The major teaching and research hospitals are more expensive not because they are inefficient but because of what they do.’”

While Obamacare continues to roll out, it is important to continue to educate friends and neighbors about the dangers the law governing them poses in restricting what Americans can spend to save their own lives and the lives of their families.

Note: the abortion-related provisions dealing with the state exchanges are described here:

Categories: ObamaCare Rationing