With the administration subsidizing insurance for millions, let’s remember there’s a difference between health insurance and healthcare access.The second annual open enrollment period for Obamacare has officially concluded, though in typical fashion, the supposedly hard deadline of Feb. 15 has been extended for those who claim to have had trouble enrolling due to long waits and a technical glitch as the deadline approached.
With the administration declaring victory because the law is now subsidizing health insurance for millions of Americans, it’s a good opportunity for a reminder that there’s an important distinction between health insurance and healthcare access.
Obamacare expands insurance coverage in two main ways — by broadening eligibility for Medicaid and by providing subsidies for individuals to purchase insurance on government-run exchanges. But just because new enrollees have something that can be called health insurance, it doesn’t mean they can rely on it when they want to see their preferred doctor or local hospital.
To start, because Medicaid pays medical providers so little, many providers simply refuse to accept beneficiaries of the program. One survey by Merritt Hawkins last year found that nearly 40 percent of doctors either limited the number of Medicaid enrollees they see, or don’t accept Medicaid patients at all.
But this may understate the access problem. As part of an investigation, the Inspector General for the Department of Health and Human Services made calls to Medicaid managed care providers who were actually listed as accepting Medicaid patients. “We found that slightly more than half of providers could not offer appointments to enrollees,” the report revealed.
Obtaining “private” insurance through a government-run Obamacare exchange doesn’t eliminate these access problems. Because Obamacare imposed a raft of regulations on insurance policies, insurers were forced to respond in several ways to cover the increased costs. One way was to hike premiums, a phenomenon that’s been described as “rate shock.” But another way has been to slash the number of doctors and hospitals that are included in their coverage network. Such “narrow network” plans have already triggered a wave of lawsuits in California.
Earlier this month, the New York Times reported on Alison Chavez, a woman diagnosed with breast cancer, who, in the fall of 2013 decided to switch to an Obamacare plan through Covered California, hoping that it would offer better coverage. “But in March, while in the middle of treatment, she was notified that several of her doctors and the hospital were leaving the plan’s network,” the Times reported. “She was forced to postpone a surgery as she scrambled to buy a new commercial policy that included her doctors. ‘I’ve been through hell and back, but I came out alive and kicking (just broke),’ she wrote in an email.”
The distinction between health insurance coverage and actual access to healthcare should figure prominently into the thinking of Republicans as they craft an alternative to Obamacare. Instead of joining Democrats in making the number of insured Americans the primary measurement of whether a policy is working, Republicans should be focused on bringing down costs and increasing the quality of American healthcare through sensible free market reforms.
