State health benefit exchanges established by the Patient Protection and Affordable Care Act were envisioned as robust marketplaces with many health plans offering a wide selection of providers. That robust marketplace is central to the law’s policy thrust to create a market in which consumers would fare far better value than in the dysfunctional pre-ACA individual marketplace, able to select from a broad range of health plans offering both value and choice of providers. More consumers thanks to premium subsidies and mandated coverage, in turn attracting a greater number of health plans and providers to tap into that enlarged market. More is better for all.
The New York Times published two stories Sunday suggesting that hoped for market vigor is proving elusive three years after most of the Affordable Care Act’s main reforms took effect and that market forces are favoring less over more. One story reports health plans driven by consumer demand for low premiums are narrowing provider networks as plans leverage market power to negotiate aggressive reimbursement rates with fewer providers. On the health plan issuer side of the market, The Times reports, there aren’t many playing in the state exchange space with consumers in large parts of the nation having only one or two exchange plans from which to choose.
Need a speaker or webinar presenter on the Affordable Care Act and the outlook for health care reform? Contact Pilot Healthcare Strategies Principal Fred Pilot by email