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Wednesday, December 11th 2013

You Can Keep Your Doctor

You can keep your insurance plan and you can keep your doctor.

Except even the former is turning out to be problematic. There’s some anecdotal evidence that these plans being offered on the exchanges are achieving their cost by fairly extreme negotiations with healthcare providers.

“My physicians will no longer be in this network of physicians, or the hospitals,” she says.


She wants to stick with the health care providers that she’s had for years, she says, including the surgeon who cared for her when she had breast cancer in 1998.

“I have full confidence in her,” she says. “And my primary care doctor has been my primary care doctor for 20 years.”


[Her] experience doesn’t surprise San Francisco-based insurance broker Susan Shargel, who’s trying to sort out all the new ways insurers are contracting with doctors. Some health plans will have fewer doctors and hospitals. Blue Shield, for example, says it will have half the doctors and three-quarters of the hospitals next year as it has this year in the individual market.


The health plan offered to Shore was a Blue Shield of California EPO — exclusive provider organization — plan. The company says it’s offering these lower-cost plans for the first time next year to buyers on the individual market. Other insurers are offering similar plans.

Patrick Johnston, president of the California Association of Health Plans, notes that the federal Affordable Care Act requires more benefits than most insurance plans have provided up until now. That includes free preventive care, a limit on annual out-of-pocket spending and a ban on lifetime caps for medical expenses. So, to keep health plans affordable for buyers on the individual market, one of the few cost variables to work with is doctor contracts.


Insurers are negotiating hard, according to Gerry Kominski, director of the Center for Health Policy Research at UCLA, saying to providers, for example: “We’re willing to pay you $50 a visit. If you’re not willing to do that, we know a doctors group across the street that will accept that.”

Rahm Emanuel’s brother, an oncologist and force behind the ACA, was making the television rounds when Chris Wallace took him to task over such.

His response to the question on whether the president promised the public that they could keep their doctors is embarrassing.

Chris Wallace: It’s a simple yes or no question. Did he say if you like your doctor, you can keep your doctor?

Zeke Emanuel: Yes. But look, if you want to pay more for an insurance company that covers your doctor, you can do that. This is a matter of choice. We know in all sorts of places you pay more for certain — for a wider range of choices or wider range of benefits.The issue isn’t the selective networks. People keep saying, Oh, the problem is you’re going to have a selective network–

It hasn’t been the best month for Dr. Emanuel who also shows some naiveté in this New York Times piece on the physician workforce.

I agree with with his logical actually. And reasonably this is a pseudomarket process going on and conservatives should perhaps champion it. It is insurance companies negotiating with physicians for the best rates.

But to me the most troubling thing is how disingenuous the public relations campaign the administration made on behalf of the Affordable Care Act was when it was being debated and passed. The health policy architects behind the plan, including Dr. Emanuel, knew you weren’t going to be able to keep your plan or your physician in more than a few cases and yet they let their bosses unabashedly sell the reform with such promises.

That’s a much bigger problem than any technical glitches with the online roll out.

It really should be unacceptable and there should be consequences for such. It shouldn’t just be ‘well this is the way it has to work, sorry we lied about it to make it happen’. The ends can’t justify the means.