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U.S. News and World Report: Top hospitals opting out of Obamacare

Americans who sign up for insurance on the state exchanges may not have access to the nation's top hospitals, Watchdog.org reports.

The Trucker News Services

11/1/2013

Though top-ranked hospitals like Case Medical Center accept plans from dozens of private insurers, if you buy your insurance on the Obamacare exchanges your options for treatment may be limited, says a Watchdog.org report in U.S. News and World Report.

The article said “Americans who sign up for Obamacare will be getting a big surprise if they expect to access premium health care that may have been previously covered under their personal policies. Most of the top hospitals will accept insurance from just one or two companies operating under Obamacare.”

"This doesn't surprise me," said Gail Wilensky, Medicare advisor for the second Bush Administration and senior fellow for Project HOPE. "There has been an incredible amount of focus on the premium cost and subsidy, and precious little focus on what you get for your money."

The article said that “responding to Obamacare caps on premiums, many insurers will, in turn, simply offer top-tier doctors and hospitals far less cash for services rendered.”

Watchdog.org looked at the top 18 hospitals nationwide as ranked by U.S. News and World Report for 2013-2014 and contacted each hospital to determine their contracts and talked to several insurance companies, as well.

“The result of our investigation: Many top hospitals are simply opting out of Obamacare.”

“For example, fourth-ranked Cleveland Clinic accepts dozens of insurance plans if you buy one on your own. But go through Obamacare and you have just one choice: Medical Mutual of Ohio.”

That's not because their exchanges don't offer options,” the report emphasized. “Both Ohio and California have a dozen insurance companies on their exchanges, yet two of the states' premier hospitals – Cleveland Clinic and Cedars-Sinai Medical Center – have only one company in their respective networks.”

A few, like No. 1-rated Johns Hopkins in Maryland, are mandated under state law to accept all insurance companies. “Other than that, the hospital with the largest number of insurance companies is University Hospitals Case Medical Center in Cleveland with just four. Fully 11 of the 18 hospitals had just one or two carriers.”

"Many companies have selectively entered the exchanges because they are concerned that [the exchanges] will be dominated by risky, high-using populations who wanted insurance (before Obamacare) and couldn't afford it," said Wilsensky, who is also on the board of directors of UnitedHealth. "They are pressed to narrow their networks to stay within the premiums."

Many exchanges don't even list the insurance companies on their websites. Some that do, like California, don't provide names of doctors or hospitals, the article claimed.

The price differences among hospitals "can be pretty profound," said Joe Mondy, spokesman for Cigna insurance. "When you are doing a cost comparison with doctors, you should look up the quality of the hospital as well. Hospital 'Y' could be great at pediatrics and not great at surgery."

Insurers operating in the exchanges are apparently hesitant to talk about the trade-off between price and quality. Two of the nation's largest insurers — Wellpoint and Aetna — refused to respond to a dozen calls and -mails placed over the course of a week, the article noted.

"There is no reason to keep that quiet. It's not going to be a good secret for very long when people want to use the plans," Wilensky said.

"In many cases, consumers are shopping blind when it comes to what doctors and hospitals are included in their Obamacare exchange plans," said Josh Archambault, senior fellow with the think tank Foundation for Government Accountability. "These patients will be in for a rude awakening once they need care, and get stuck with a big bill for going out-of-network without realizing it."

All of this represents a larger problem with the Affordable Care Act, said Archambault, who has extensively studied the law.

"It reflects deeper issues in implementation," he said. "Some hospitals and doctors don't even know if they are in the network."

Seattle Children's Hospital ranks No. 11 on the U.S. News & World Report best pediatric hospital list. When Obamacare rolled out, the hospital found itself with just two out of seven insurance companies on Washington's exchange. The hospital sued the state's Office of Insurance on Oct. 4 for "failure to ensure adequate network coverage."

"Children's is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest," a hospital press release said. " Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation."

And for doctors in Texas, "Basically, we don't know," said Stephen Brotherton, president of the Texas Medical Association. "We can't find out. At this point, it's part of the various unknowns with the marketplace. There are ways you can be on plans and not even realize it."

The Trucker staff can be reached to comment on this article at editor@thetrucker.com.

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JB Hunt