- The Affordable Care Act (ACA) was meant to increase access to medical care, but low-cost plans in the individual market exchanges often deny access to top quality cancer doctors, a new study in the Journal of Clinical Oncology shows.
- Researchers from the University of Pennsylvania looked at how often oncologists affiliated with 69 National Cancer Institute-designated (NCI) treatment centers were covered by narrow-network plans, which tend to have lower premiums. They found doctors at those centers were twice as likely to be excluded from the narrowest network plans.
- “Most common cancers can be treated well anywhere,” Justin Bekelman, associate professor of radiation oncology, medical ethics and health policy at the University of Pennsylvania and one of the researchers, told Bloomberg. “But there are many patients with rare or uncommon tumors who need access to the most advanced clinical trials, and that access is often only at these NCI cancer centers."
The narrow provider networks may not limit just choice, but also the level of quality care as compared to larger networks, the study's authors note. They call for accurate information and transparency around health plan networks, as well as provider directories that denote a provider’s clinical expertise — e.g., NCI affiliation or other care quality indicators.
The share of low-cost healthcare policies with narrow networks has grown from 48% in 2014 to 53% this year, according to McKinsey & Co. In fact, narrow networks constituted the majority of plans offered by both incumbent and new carriers on the ACA exchanges in 2017. And for obvious reasons: Narrow network plans cost about 18% less than the broad network silver plans. They also have been performing better financially than the more expensive plans, McKinsey says.
A narrow network option can be good for a relatively healthy person, but as this study shows, people who need specialty care or high levels of care could find themselves with no providers available without hefty out-of-network costs. Plans with narrow networks also contribute to the issue of surprise medical billing, because patients don't always realize they are being cared for by providers not in their network.
According to a study last year in Health Affairs, health plans with small networks had premiums 6.7% lower than broad network plans, making them an important strategy for offering lower-cost marketplace plans and thus more expansion of coverage.
With the June deadline just passed for carriers to decide to remain in the exchanges and set their rates for 2018, it will be interesting to see who stays and who goes. Offering more narrow network plans could be a strategy for payers who want to continue to offer plans but have been losing money in the market.
A recent Kaiser Family Foundation study found that medical loss ratio for insurers in the individual market — the percentage of premium dollars an insurer spends on medical claims — dropped to 96% in 2016, the best since the ACA exchanges were created. But to be profitable in the individual market, that number needs to be between 85%-90%.
Uncertainty about the ACA and whether Republicans will continue to pay cost-sharing reduction payments to insurers could also affect insurers’ decision about whether to continue in the marketplace. The Center for Budget and Policy Priorities has warned that uncertainty will trigger higher rates and more payers will drop out of the exchanges, further destabilizing the individual market. That could mean fewer people who can afford health insurance of any type and less access to affordable quality care.