<p>But those people liked and could afford those plans. It was their choice. Now no more choice.</p>
<p>(Responding to emilybee’s comment).</p>
<p>Off-exchange buyer are also higher income since they’re not seeking subsidies. So slowly those prices will rise. That’s my prediction. We’ll see.</p>
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<p>Wait, I thought your complaint upthread was that the exchange plans were going to be MORE expensive?</p>
<p>Does a doctor even have a choice to participate with “new health insurance products sold on an ACA exchange”, as distinct from participating in the individual insurance market as a whole? That is, can a doctor really say he’ll take Aetna subscribers who bought individual insurance off the exchange, but not Aetna subscribers who bought policies on the exchange? Are insurance companies breaking up their provider networks that way?</p>
<p>That was very interesting reading, bclintonk! Thanks for the link! </p>
<p>Here’s a chart showing the state-by-state listing of Medicaid:Medicare fee index:</p>
<p>[Medicaid-to-Medicare</a> Fee Index | The Henry J. Kaiser Family Foundation](<a href=“http://kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/]Medicaid-to-Medicare”>Medicaid-to-Medicare Fee Index | KFF)</p>
<p>Since the ACA authorizes federal funding to equalize Medicaid rates to 100% of Medicare rates for primary care services, this should have an effect on physicians’ reluctance to accept Medicaid patients. BUT do primary care practitioners generally limit the number of Medicare patients? Although most accept them, do they limit the number they have at any given point in time? If many negotiated rates for provider reimbursement on the exchange plans are equivalent to Medicare rates, is this not going to cause a real lack of providers for people who have policies through the exchanges or expanded Medicaid? Will the old (Medicare), the poor (Medicaid) and the subsidized (as most on the exchanges will be) be fighting for limited spaces in physician practices?</p>
<p>Eventually…</p>
<p>bclintock, yes, the article has a tabloid quality to it, but if the poll is accurate then it should be a concern for all of us who have to select one of the ACA-compliant plans next year. </p>
<p>My problem is that I have to make a decision by Dec 15, and I don’t know which doctors are going to be in which networks. This is ridiculous that doctors don’t know what their reimbursement rates will be and, therefore, will not sign up for the exchange networks, yet I am forced to make a decision by Dec 15 if I want insurance next year.</p>
<p>“But those people liked and could afford those plans. It was their choice. Now no more choice.”</p>
<p>Not according to the stats. They also didn’t a choice. It was accept an individual policy which was expensive and left you under-insured or go without insurance.</p>
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<p>Well we’ve had a bunch of people on here who were cancelled who created an account on the healthcare.gov site to see what their options are. </p>
<p>If you look at the news stories on people who are cancelled they become ‘customers’ of the web site. At least going as far as finding out what their quotes are. So they are being cited in the success numbers for ACA.</p>
<p>All those unhappy people being quoted in article after article had a choice. They had cheaper plans that they could afford. It’s the ACA plans that are more expensive.</p>
<p>CTTC: It seems the insurance companies offering policies on the exchanges are limiting the networks. The doctors on the networks I suppose will make up the difference in reimbursements by volume. For instance, having more physician’s assistants seeing the patients.</p>
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The insurance companies that participate on the exchanges are required by law to set the same price for identical plans sold off-exchange. So relative pricing is likely to stay very close to the same.</p>
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<p>This is all contractual between the insurers and the providers, but I think many insurers require providers to accept all their insurance products, or none; they can’t cherrypick the particular kinds of policies they’ll accept. That’s why in the New York survey 3/4 of the physicians who said they “are participating” in the exchange said they “had to participate” because of contractual obligations. So if you’re a physician in New York and you want to continue to accept Empire BCBS, you may need to accept Empire BCBS’s exchange policies as well. That’s why I expect many of the physician practice groups that are still undecided about participating to eventually jump into the pool–some may find they’re contractually obligated, others may find they’re cutting off too much of their core business if they turn away all the insurance lines offered by all the insurers who are selling policies on the exchanges.</p>
<p>On the other hand, there have been some reports indicating that some insurers may be intentionally trying to keep provider networks for exchange policies narrow, as a cost control measure. It’s hard to know who to believe. Could be both, I suppose: insurer wants to keep the network narrow to contain costs so it low-balls all the providers on reimbursement rates, expecting to drive most of them away, while those it keeps it’s got at a low price.</p>
<p>Tatin, cheaper until you had to use them and then what? Dropped when you developed a condition that had to be treated and/or no coverage for that when you exceeded your lifetime cap. </p>
<p>I am sure plenty of healthy people think those policies are great - until they get sick and the cost of their medical expenses put them into bankruptcy.</p>
<p>“If you look at the news stories on people who are cancelled they become ‘customers’ of the web site. At least going as far as finding out what their quotes are. So they are being cited in the success numbers for ACA.”</p>
<p>Most should look at policies on the exchanges because most will be eligible for subsidies and they will be paying less than for a plan off the exchange.</p>
<p>But it was their choice. They knew the risks. There are some who think people cannot make these decisions for themselves and have to have government make it for them.</p>
<p>People previously did not, in fact, have the opportunity to buy ACA-compliant policies, because such policies didn’t exist. That choice was not available.</p>
<p>Yes, but the only people who seem to want them are the people getting them for free. Observation.</p>
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<p>The point is that there is a benefit to Obama to cancel these individual policies because it drives people to his web site. Thats what CF disputed.</p>
<p>Observe harder. A lot of people, including people without subsidies, are getting cheaper, better insurance. Like, we suspect, our Bookiemom. And some are paying more, and some are paying a lot more (like our Goldenpooch and poetgrl). And some are able to buy insurance at all, when they couldn’t before.</p>