Obamacare: The Phantom Network

Even fans of Obamacare in theory are experiencing disillusionment with the program in practice.

An LA Times piece published Tuesday cites current Obamacare customers who are less than thrilled with their coverage. Danielle Nelson lost her insurance plan when her provider, Aetna, pulled out of the California market over concerns about the new health exchange. Danielle was promised by her new provider that her oncologist would be covered but when she went to his office she found a sign saying Covered California was not accepted.

“I’m a complete fan of the Affordable Care Act, but now I can’t sleep at
night,” Nelson said. “I can’t imagine this is how President Obama wanted it to happen.”

After numerous complaints, her insurer agreed to extend her ability to see her oncologist through March. 

Maria Berumen should be an Obamacare success story. At age 53 she had preexisting conditions which made finding insurance so expensive she remained uninsured. Under the new law she received a large subsidy payment which meant she could buy insurance for herself and her husband for under $200 a month.

Maria saw a doctor for numbness in her arm and shoulder and was referred to a specialist. But four doctors who were supposedly in her network (according to the exchange website and her insurer) would not accept her plan. She tells the LA Times “It’s a phantom network.”

Insurance industry experts have warned for months that the structure of Obamacare would necessarily lead to reduced provider networks. Back in November, Bob Laszewski wrote that since insurance providers could no longer compete on coverage (since all Obamacare plans require the same coverage) network size had become a key way to compete on price. He wrote “Clearly, one of the consequences, intended or unintended, of Obamacare
has been a dramatic escalation in the use of provider networks to vary
health insurance exchange premiums.”

It seems possible many of these problems will shake out over time. Nevertheless, this is another instance in which the transition to Obamcare has been disappointing, even to people who were prepared to be thrilled with it.