(Bloomberg) — Insurers participating in Obamacare may have to expand their plans to include more federally funded health clinics, safety-net hospitals and other medical providers used by low-income people, under a U.S. proposal.
Health plans offered through government-run insurance exchanges may be required to cover 30 percent of “essential community providers” in each county in 2015, an increase from 20 percent this year, according to a document obtained by Bloomberg News. The proposal will be outlined today in a letter to insurers from the Health and Human Services Department.
As millions of Americans join health plans created through the 2010 Patient Protection and Affordable Care Act, consumers and regulators are paying greater attention to the breadth of available coverage. Insurers say smaller networks of hospitals and doctors help contain costs and improve care. Providers serving low-income people have complained that exchange plans won’t allow them to join the networks, said Sara Rosenbaum, a professor of health policy at George Washington University.
“Everybody is obviously very concerned that what’s going to happen is their patients will be swept away — they will not be identified as preferred providers in networks,” Rosenbaum said in a phone interview. “Clearly something has set off alarm bells.”
About 3 million people signed up as of Jan. 24 for private health insurance plans offered by the new marketplaces, HHS has said. WellPoint Inc., the second-biggest U.S. insurer, said it had added 500,000 members through the exchanges set up by the law known as Obamacare.
More than two-thirds of health plans on exchanges have assembled provider networks considered “narrow” or “ultra- narrow,” in which as many as 70 percent of hospitals and other local health providers aren’t included, according to a December study by the consulting firm McKinsey & Co.
Narrow networks allow insurers to negotiate lower prices with hospitals and doctors, which can be passed on to consumers in the form of lower monthly premiums. The insurance industry argues the practice also allows them to more closely manage the care of their patients, benefiting their health.
Exchange plans with broad networks of hospitals carry premiums 26 percent higher, on average, than similar plans from the same carriers with narrow networks, according to the McKinsey study.