Rich Daly | January 19, 2015
Jan. 19—Policy changes are needed to reduce negative effects of the growing use of both narrow provider networks and high deductibles, according to a liberal advocacy group closely tied to the Obama administration.
The Center for American Progress (CAP), which includes numerous former administration leaders, issued a post-Affordable Care Act (ACA) blueprint on needed healthcare reforms.
Among the four goals the organization underscored in its Jan. 19 report as needed to improve the U.S. healthcare system was improved access to care. Specifically, the plan urged new state and federal laws or rules to ensure health plans’ provider networks “deliver meaningful access to care and that plans publish accurate directories of the providers that are in their networks.”
The proposal followed a growing number of complaints and legal actions by providers and consumer advocates challenging the rise of narrow network plans. Such plans have dominated the ACA’s public marketplaces, according to an analysis, and a growing share of employer-provided plans feature such limited networks as a cost-saving tool.
“When such networks fail to provide appropriate, timely, geographically-accessible care, health plan enrollees should be able to obtain care outside of the network at no extra cost,” the CAP authors wrote.
Similarly, the organization urged barring additional out-of-pocket costs to receive care at an in-network hospital from a clinician who is not in-network.
The organization also sought to improve provider access for Medicaid beneficiaries by urging a federal law to permanently set Medicaid rates at higher Medicare levels. A two-year bump in Medicaid primary care pay rates to Medicare levels expired in 2015.
“Access to Medicaid providers can vary significantly by state, within a state, or by specialty, depending on how many providers there are and what they are paid,” the authors wrote.
Deductibles Targeted
Additionally, the CAP report urged limits on the use of high deductibles in ACA marketplaces and new federal subsidies to cover such out-of-pocket costs. High-deductible plans covered about 45 million Americans in 2013, which was a 15 percent increase from 2012, according to the American Association of Preferred Provider Organizations. Additionally, nearly one-third of large employers will offer only high-deductible plans next year, according to the National Business Group on Health.
“These deductibles are often thousands of dollars per person, which can make needed health care unaffordable,” the authors wrote.
To reduce the impact of high deductibles, the report urged a new requirement that every insurer selling plans in the ACA marketplaces offer at least one plan in each metal tier that exempts “important services” from the deductible, such as primary care visits. Additionally, the report urged expanding the federal subsidies to reduce cost sharing that already are available to enrollees with incomes of up to 250 percent of the federal poverty level.
Source: HFMA
https://www.hfma.org/Content.aspx?id=27489