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<p>Why would you say that? It seems to me it would be much easier. It’s computer to computer; no pesky human interface to have to worry about. Plus, it’s not real time, so no worrying about peak loads. They can easily do the entire thing in batch mode. True, they have to work with the formats for all the insurance companies, but still, it should be easier.</p>
<p>* it could expose earlier enrollment numbers as flawed and spark a renewed wave of politically charged investigations* What do you know about Parente, cat?</p>
<p>In general, “could” is a careful alternative to “will.” But we don’t have further info yet. </p>
<p>Would that be Stephen T. Parente, health policy advisor to McCain 2008? That’s not someone I would look to for an unbiased assessment of the ACA. A Republican advisor telling me what “could” happen? This is not a serious statement. It’s chaff.</p>
<p>Re wider networks: There is nothing in the law that either mandates or prohibits wider networks. That is entirely a market-based decision by the insurers. Since it seems this has been one of the major complaints this year, I just bet that some enterprising insurer will decide to expand them in order to grab that slice of the market. No, not a guarantee. But we have faith in the invisible hand, don’t we? If there’s a profit to be made, someone will do it.</p>
<p>Let’s see…before Obamacare wider networks no problem. After Obamacare, no more wider networks. I guess it’s just coincidence.</p>
<p>Actually I had to watch which plans we chose in the past due to network selection. I always selected based on which plans had our kids’ pediatrician, and not all did. We always bought 2 family plans (due to my fear of the caps) so several years we had the Aetna primary insurance which accepted our preferred physicians but my H’s insurance with BCBS didn’t. </p>
<p>The fact is that insurers have always limited networks in some way preACA. The question is not whether there is insurer limitation on providers, but whether that limitation level is acceptable; and if not, how do we change it. </p>
<p>This is a simple math problem. I don’t understand how people are missing the very simple point that this is cost-cutting. there wil not be a demand for wider networks unless they are affordable and since most people are subsidized now it’s obviously not affordable already… Good grief.</p>
<p>How do narrower networks lower costs? Serious question. What increased costs are associated with having more docs in the network? </p>
<p>One of the many problems is the reimbursement rates to doctors. They are refusing to participate. here’s an old article that explains it pretty well.</p>
<p><a href=“http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/13/obamacares-narrow-networks-are-going-to-make-people-furious-but-they-might-control-costs/”>http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/13/obamacares-narrow-networks-are-going-to-make-people-furious-but-they-might-control-costs/</a></p>
<p>There are two ways narrower networks lower costs. First and most obviously, they lower costs by eliminating higher cost providers. We’ve talked about Cedars Sinai in this thread before. There may be an argument about whether Cedars provides better care, but there is no doubt that they charge more than twice as much as other providers for the same procedures. People don’t want to pay for somebody else in their insurance plan to get their appendectomy at Cedars when they could have gotten a perfectly good appendectomy at a more reasonably priced hospital.</p>
<p>Second, when insurance companies are negotiating with providers, the providers may agree to accept lower reimbursement in exchange for exclusivity. For example, a pediatric group might not be willing to accept $X per visit to see two or three kids, but if they know they have a steady stream of kids from this insurer, suddenly $X per visit looks good.</p>
<p>True, CF except that most provider groups have figured out what they need to make per patient to keep the doors open. So, whether is 100 patients or 1000 patients, losing money is losing money and they will have to opt out. Now, I suppose they could shuffle the workload to PA’s and cut visit time, etc. But, there goes quality of care and some will not be willing to practice in that fashion. </p>
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<p>I find this statement strange. What am I to conclude about your position: that insurers should provide plans with wider networks even though people don’t want to buy those plans? And even though the wider-network plans would cost more?</p>
<p>Well, they cost more now. Pre-ACA they were readily available at affordable rates. In other words, costs have not gone down, but networks have been narrowed in some places to next to nothing. That’s what I meant.</p>
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<p>Where “readily available” here means “not available if you were likely to want to use those networks.” </p>
<p>I still don’t understand the point you’re making, actingmt. You say that insurance policies that include wider networks would cost more, and I agree. Then you say that there wouldn’t be enough demand for such policies; I’m not so sure about that. But you seem to believe that insurers should offer policies with wider networks even though people wouldn’t buy them. </p>
<p>"Insurance companies have been using limited provider networks for a long time. It’s how they conducted business before Obamacare came along and, for better or worse, it’s how they’ll conduct business now that Obamacare is law. "
<a href=“http://www.newrepublic.com/article/115738/obamacare-provider-shock-gop-spreads-another-myth”>http://www.newrepublic.com/article/115738/obamacare-provider-shock-gop-spreads-another-myth</a></p>
<p>The point I’m making is not a big deal. Networks have been slashed because of ACA cost-cutting measures. Premiums have not been slashed. But more people are being insured. Thus, those paying full freight are getting less for more. This is not news. </p>
<p>And just because things happened before does not mean ACA didn’t make it worse. Premiums always rose. Networks always shrank. Now, these problems are dramatically worsened. Pre-existing conditions are better. Children being 26 years old is just weird. Roughly 50-percent of the population is on Medicaid. And, that’s only 3 of 3,000 pages.</p>
<p>Oh, I see. Yes, that is true: people paying full freight are getting less for more, because they are now paying to cover sick people who previously couldn’t buy insurance.</p>
<p>I suggested that LF post the New Republic article, but I didn’t notice the URL. I recommend that people ignore the inflammatory URL and check out the article, which is a non-inflammatory discussion of narrow networks. In particular, the article notes that insurers have been narrowing networks for decades in order to bring down costs.</p>
<p>in the article, Karen Pollitz of the Kaiser Foundation offered this insight:</p>
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<p>If the people who are very very upset about narrow networks are representative of a larger group of subscribers, then wider networks will be offered in the future (apply Fang’s Razor to health insurers). </p>
<p>If OTOH, the people who are very very upset about narrow networks are NOT representative of a larger group of subscribers, but are instead representative of a few unprofitable outliers, then wider networks will NOT be offered in the future (again, apply Fang’s Razor to health insurers). </p>
<p>This is purely a free market question, and the free market will address it one way or the other. Of course, it may not address it to the liking of the very very upset people. But that’s the downside of free markets, eh?</p>
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<p>What? The population of the US is 314 million. Last year, 59 million people were on Medicaid. So far, Medicaid has seen about 7 million new enrollees, counting the newly eligible, the “woodworkers” who were already eligible but had not signed up, and people transferred from other state health programs to Medicaid.</p>
<p>That’s 59 million plus 7 million, for 66 million. Sixty-six million is not half of 314 million. Not close.</p>
<p>I think LasMa is being too harsh here. The people upset about narrow networks might be profitable outliers, assuming they are outliers. I suspect GP is a profitable insurance consumer. The trouble for insurance companies considering offering wider networks is not healthy GP. It’s the unprofitable people who know they will need lots of care this year, and who would be happy to have that care delivered by expensive providers. </p>
<p>GP wants a wider network because of his peace of mind. But if I knew I’d need six operations this year, I might want a wider network for the Picassos and the espresso girls. Adverse selection is real.</p>