Democrats like to talk a lot about being the party of choice, but under Obamacare, individuals are finding their choices increasingly limited.
At its core, Obamacare forces individuals to purchase government-approved insurance policies and precludes them from buying plans that might be more in line with their healthcare needs.
Though Obamacare's defenders argue that the requirements imposed on health insurance plans only serve to guarantee that individuals have better coverage, in reality, what's happening is that the law is driving insurers to limit choices.
The problem is that Obamacare imposes a raft of regulations on insurance policies. Insurers have responded, to some extent, by hiking premiums. But they've also reacted by reducing the number of doctors and hospitals offered within their healthcare plans to keep down their costs.
These "narrow networks" have frustrated consumers since Obamacare started offering insurance coverage in 2014, but the problem has grown worse – putting consumers in restrictive plans that they overwhelmingly rejected decades ago.
There was a time when HMOs, or health maintenance organization plans, were keeping a tight lid on spending and forcing individuals to meet their healthcare needs within an established network to get reimbursed. But there was a huge public backlash against the restrictiveness of such plans. By 1997, audiences would famously cheer Helen Hunt's character in the 1997 film "As Good as It Gets" when she went off on HMOs in a profanity-laden tirade.
By the 2000s, most consumers gravitated toward preferred provider organizations, (or PPOs), which offered discounts for staying within a network of providers, but allowed more flexibility to seek care out of network.
Obamacare, however, has helped usher in a more restrictive system once again. Last month, a pair of studies revealed that fewer and fewer plans offered on the Obamacare exchanges are PPOs.
An Avalere study found a 31 percent decline in the percentage of PPOs being offered on the exchanges, while the number of HMOs and similarly restrictive exclusive provider organizations rose. A previous study by the firm found that in 2015, Obamacare exchange plans had 34 percent fewer providers within their networks than the average for commercial plans.
These findings were reinforced by a study from the Robert Wood Johnson Foundation, which found that only 33 percent of 2015 silver plan PPOs remained available for the 2016 benefit year as insurers either dropped the plans or exited markets. In 22 states, all of the PPO offerings for 2015 were either dropped or reduced and only 11 states maintained their offerings.
Another Johnson Foundation study released this month found that even within the PPO plans that remained, it's becoming more difficult for consumers to seek care out of network. The study found, "an additional trend has been toward a reduced scope of coverage in PPOs that are currently offered."
For instance, fewer PPO plans now cap out of pocket spending for out of network providers, meaning that individuals in these plans that go outside a preferred provider risk exposing themselves to massive medical costs. Those PPOs that still have caps have tended to increase the caps. In effect, this traps more individuals within the networks.
So, to sum up: Obamacare exchanges are offering fewer PPOs and more HMOs while the PPOs that remain are increasingly resembling HMOs with their tight leash on consumers seeking outside care.
Though the Department of Health and Human Services has proposed various regulations aimed at improving the scope of provider networks, the problem is that to the extent that these regulations are effective in expanding networks, they will drive up premiums, and if they don't drive up premiums, they won't do much to change the overall trend.
If anything, the trend is likely to accelerate. Because Obamacare insurers have had trouble enrolling enough young and healthy individuals, they've been incurring greater than expected medical losses.
This is only going to spur them to find savings by hiking premiums and reducing networks further. And given the rapid escalation of premiums, many consumers will be forced to purchase increasingly restrictive plans just to be able to afford any sort of insurance.
So much for Democrats being the pro-choice party.