The Network Issue

Another area in which the Affordable Care Act will have an impact on health care in America is beginning to get some attention.  It has to do with the “provider networks” — that is, the collection of doctors, hospitals, and other health care facilities and personnel being offered by some of the new insurance plans.

The Affordable Care Act posed some difficult challenges for insurers.  Under the statute, they were required to include a number of new, mandatory forms of coverage in their health care plans.  That requirement, obviously, limited the ability of insurers to control the costs of particular plans by tailoring the kinds of care covered by those plans.  But the insurers still need to figure out a way to control costs, because their plans need to be competitively priced.

There aren’t a lot of remaining cost-control options. One is to tinker with things like co-payments and deductibles and increase the non-premium payments that the insureds must make when they use health care.  Another is to limit the networks to particular health care providers who, due to location or contractual agreement or some other consideration, are offering health care at lower prices than their competitors.

That’s the gist of an article in the Wall Street Journal by a cancer patient whose existing policy has been canceled and who can’t find a substitute policy that includes all of the providers that have given her the unique combination of care that has allowed her to beat the odds and survive.  It’s an indication of the kind of long-term effects that will play out over time, as the Affordable Care Act reshapes the health care market.  In the individual market, at least, Americans who are used to going to whichever doctor and hospital they choose may need to change their habits — and they probably won’t be very happy about it.