Bailey Comment: " I'm thinking this is one of the reasons that the Canadians come over here for medical. Now that ours is just as crappy, where are they gonna go?"
Federal and state regulators and lawmakers are stepping up pressure
on the insurance industry for offering plans under ObamaCare that limit
access to doctors and hospitals -- a strategy insurers say is necessary
to keep coverage prices low in the health law's marketplaces.
The Wall Street Journal reports that some state legislatures are
weighing bills that could force insurers to add more hospitals and
doctors to plans, while federal regulators have proposed a tougher
review process for plans to be sold next year through HealthCare.gov.
The access problem is a byproduct of the effort to drive down costs
of subsidized coverage, prompting insurance companies to offer limited
choices of doctors and hospitals.
Under a federal proposal announced this week, insurance companies
selling plans in the federally-run marketplace would be required to
submit to the government a full list of providers in a network before
the plans are approved for the exchanges, The Wall Street Journal
reported.
A spokesman for the Centers for Medicare and Medicaid Services told
the newspaper it is "working to strengthen the network adequacy
requirements that took effect for this year."
In Washington state, Seattle Children's Hospital has sued over the
state insurance department's decision to approve networks that didn't
include the facility. The hospital is excluded from five of seven plans
on Washington’s state insurance exchange, according to Bloomberg News.
The hospital says is struggling to get paid for care given to about
125 children it has treated since Jan. 1, when ObamaCare coverage took
effect. The facility will be required to pick up costs beyond the
standard deductible if insurers refuse to cover their services.
"We made the decision to see all the children," Sandy Melzer, the
facility's strategy officer, told Bloomberg News. "Maybe we’ll be paid,
maybe we won’t. It’s completely done on faith."
The family of 5-month-old Gabriella Blankers visited Seattle
Children’s last month for a CT scan that found a rare birth defect. They
said they were initially rejected by their insurer because the hospital
wasn't in their network, though the insurer later made a temporary
exception, according to the report.
"There’s nowhere else I could go," to get the care Gabriella needed,
Rebekah Blankers, the girl’s mother, told Bloomberg News. "Unless I went
out of state, out of network, or out of pocket."
Lawmakers in a Washington state Senate committee heard a proposal
this week that would reportedly allow health insurance companies to keep
offering insurance plans that don't meet the new federal and state
requirements. But they would only be offered to people who were enrolled
in such plans as of Oct. 1, 2013.
Senate Bill 6464 also would let insurers from other states sell plans
to Washingtonians without requiring the carriers to meet Washington
state insurance regulations.
When President Obama announced he would leave it up to the states to
decide whether to continue to offer some old plans for a while,
Washington's Insurance Commissioner Mike Kreidler said he would not
allow it.
Meanwhile, in Mississippi, proposed legislation would bar insurers
from cutting off most doctors and hospitals that agree to prices set by
insurers. The bill also would prohibit insurers from charging higher
copayments at certain doctors' offices or hospitals, according to The
Wall Street Journal.