Obamacare Exchange Plans Have 34 Percent Fewer Providers than Non-Exchange Plans



Avalere Health has quantified how narrow networks are in Obamacare exchange plans, as shown in the figure below.

According to Avalere CEO President Dan Mendelson: “Plans continue to test new benefit designs in the exchange market. Given the new requirements put in place by the ACA, network design is one way plans can drive value-based care and keep premiums low.”

Well, that is one way to look at it, and I hope Mr. Mendelson is right.

On the other hand, there are other indications that insurers are designing plans to attract healthy applicants and shun sick ones. I fear that this research builds on that case, because the networks of specialists (oncologists, cardiologists) are much narrower than the networks of general practitioners.

That is what you would do if you were designing a network for the healthy—ensure adequate access for those who need only their annual preventive visit (free under Obamacare) but reduce access for patients who need specialty treatment.

I don’t want to go overboard here. It may well be that there are greater differences in quality among specialists than general practitioners, in which case it would be quite reasonable to characterize a very narrow network of specialists as high value.

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For the pivotal alternative to Obamacare, please see the Independent Institute’s new book, A Better Choice: Healthcare Solutions for America, by John C. Goodman.

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