California lawmakers have put forward several bills designed to solve a problem created by the Affordable Care Act. The problem is small provider networks that make it difficult for some people to find a doctor.
The problem stems from the design of Obamacare, which requires insurers to offer a standard package of coverage and to offer insurance to everyone regardless of their health. Unable to adjust costs by limiting coverage or by limiting access, insurers were left with one way to compete on price: limiting provider networks.
In the case of some major California insurers, the networks were initially too small for the number of people in them. Some Californians began to complain that, though they had insurance, they were unable to find a doctor who would see them.
Insurers have been making efforts to expand some of these networks to address the problem. The Sacramento Business Journal reports, “Anthem has added 6,300 doctors to its narrow network since January andnow has a total of 38,000 statewide… Blue Shield has added 40more hospitals and 15,000 doctors to its statewide network in the lastyear.”
But California lawmakers are also trying to address the issue through legislation. Senate Bill 964 adds reporting requirements for Covered California and Medi-Cal plans. The goal is to insure that state regulators can step in if wait times to see a doctor become excessive. In cases where a patient suffers harm as a result of delays, the state would be able to assign penalties to the insurer.
Meanwhile, Assembly Bill 2533 would require insurers to help patients access out-of-network doctors in any case where in-network doctors are not available on a timely basis. The insurers would not be able to charge any additional co-pays for this service.
The insurance industry is strongly against AB 2533. A spokesman for the California Association of Health Plans, the industry’s trade group, told the Sacramento Business Journal the bill, “goes in the wrong direction.” That direction, under Obamacare, is toward smaller, tightly managed networks.