Choice of Health Plans and Doctors

You pays your money and you takes your choice.

Punch Magazine,  1846

In 2009 President Obama made two promises:

One, “If you like your doctor, you can keep your doctor.”

Two, “If you like your plan, you can keep your plan.”

These promises  remain true in some circumstances.  But your choice may cost you.   If your doctor is not in the health plans’ network, you will pay more or maybe not at all.   And you may not have a choice, or your choices will be limited.  Many health plans are not participating in the health exchanges.   And many employers make the choice of health plans you can participate in.

Major health plans -  Wellpoint, Aetna, Cigna, and UnitedHealth -  are sharply narrowing the number of plans included in their networks.    If your doctor is “out of network,” you may end up paying out of pocket for your care.     A McKinsey study indicates 47% of HMOs are planning on narrowing their networks. Others types of health plans – high deductible plans, point of service plans, an preferred provider organizations – are pursuing similar strategies.

These plans are betting employers and consumers will choose premium price over plan and doctor loyalty.  The plans think they can cut premiums by 10% to 15% by selecting the less costly doctors  and hospitals.   They are also wagering that they can sell the concepts of better quality and better outcomes from selected providers.   Their studies indicate that people buying into the exchanges will be willing to sacrifice choice of providers for price.   Many consumers,  in states like New Hampshire,  will have no choice. 

In the 1990s,  this strategy backfired. There was a backlash against restricted choice and channeling of care through certain doctors.   But economic times have changed.    The five year recession persists,  health costs have inflated, and Obamacare is the law.

Obama’s original promises have been modified to read:  If you want to keep your doctor and your health plans, you can – for a price, and if your doctor and your plan  are still available on the exchanges.

Tweet:  Health plans are narrowing choices of doctors and plans.  If you choose plans outside network, you will have to pay higher prices