Access Shock: California's Shrinking Obamacare Coverage Networks

Posted: Sep 29, 2014 4:29 PM

The Obamacare program in America's largest state may be called "Covered California," but simply holding an insurance card in one's wallet does not guarantee one access to needed health appointments. Obtaining "coverage" is distinct from receiving actual care.  The Los Angeles Times reports that the state's Obamacare provider networks will remain narrow in 2015, with some contacting further:

Finding a doctor who takes Obamacare coverage could be just as frustrating for Californians in 2015 as the health-law expansion enters its second year. The state's largest health insurers are sticking with their often-criticized narrow networks of doctors, and in some cases they are cutting the number of physicians even more, according to a Times analysis of company data. And the state's insurance exchange, Covered California, still has no comprehensive directory to help consumers match doctors with health plans. This comes as insurers prepare to enroll hundreds of thousands of new patients this fall and get 1.2 million Californians to renew their policies under the Affordable Care Act. Even as California's enrollment grows, many patients continue to complain about being offered fewer choices of doctors and having no easy way to find the ones that are available.

One major insurer is hiking rates and dramatically curtailing access, explaining that costs would have shot up even more if they'd simply maintained their previous network:

Health Net has proposed the most dramatic change for 2015, the data show. It's dumping the PPO network that Edwards and others purchased and switching to a plan with 54% fewer doctors and no out-of-network coverage, state data show. Yet premiums for that stripped-down policy are going up as much as 9% compared with pricing for the PPO. State regulators have questioned the company's moves. Health Net said its cutbacks were necessary to avoid even steeper rate hikes and it's confident the smaller network will be sufficient. Its separate HMO network is unchanged for 2015 after about 4,000 doctors were added this year. The insurer is following the lead of its two rivals Anthem and Blue Shield, which opened last year with sharply limited networks.

"Covered" California.  Adding to the frustration, beneficiaries still can't access a reliable provider directory, as the state pulled down its initial version following complaints of rampant inaccuracies.  The resulting confusion has caused real financial consequences for consumers:

There's no timetable for a state provider directory after the exchange scrapped an initial version that was riddled with errors. Instead, Covered California refers people to insurance company websites that vary in usefulness...Some consumers have been saddled with huge medical bills after insurers refused to pay for care deemed out of network...Mary Edwards, a 63-year-old librarian in Mar Vista, was excited about a Health Net PPO she picked out last fall because it offered a wide selection of doctors at a reasonable price. But it turned out that several physicians listed on her plan didn't accept the insurance or weren't taking new patients. "This is part of the Affordable Care Act that doesn't quite work yet," Edwards said. "This game of who's in and who's out is tiresome."

Perhaps California officials should redouble their efforts to get this critical information into the hands of existing consumers before spending tens of millions of taxpayer dollars in an expensive effort to attract new ones.  According to the Wall Street Journal, “to get new enrollees, the California September launched ads featuring residents talking about how coverage under the health law has benefited them, part of a $46 million statewide advertising campaign.”  Meanwhile, "there's no timetable" for an accurate state provider directory.  But remember, friends, the law is "working well" in the real world because the alleged experts say so.