In the early stages of Obamacare, medical professionals and policy experts warned that health plans sold on the law’s exchanges would likely have “narrow networks,” a euphemism for limited access to doctors and services. They said that could create problems for consumers wishing to keep their doctors.
Obamacare critics sounded the alarms over narrow networks ahead of the midterm elections last year. The conservative group Americans for Prosperity launched an entire campaign warning of the consequences that would ensue with narrow network plans. In some areas, those alarms rang true, depending on where one lived and which plan one chose.
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However, now that Obamacare has taken hold -- yesterday the administration announced that about 12 million people signed up through exchange plans this year -- researchers are starting to get a glimpse of how narrow networks actually compare to commercial plans.
In the first study of its kind, researchers from the University of California Irvine and the University of Wisconsin Madison examined data from Covered California plans, which in some cases have much narrower networks than employer-based plans in the state.
In the study, published in Health Affairs, the researchers zeroed in on hospitals in the networks, not doctors, though that will likely be next. They found that narrow network plans didn’t show a comparable difference in access or the quality of care patients received compared to those enrolled in commercial plans with wider networks.
The study looked at the four top health plans in California: Anthem Blue Cross, Blue Shield of California, Health Net and Kaiser Permanente. They compared geographic access between the plans and found there was at least one hospital within a designated market area for at least 92 percent of the Covered California plans, compared to 93 percent in commercial networks.
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The researchers said there were some access problems, but those existed for both plans sold on the exchange as well as commercial plans.
When it comes to quality, Covered California plans tended to perform better than other plans. In the Joint Commission’s “Top Performers” rankings, Covered California plans performed better than any other group.
This “indicates that the average quality in the (Covered California) networks is actually higher than in the commercial networks,” the researchers said in the study. "It seems plausible that insurers are deliberately excluding some hospitals that have not been designated as top performers.”
Of course, those metrics, both quality and access, only measured hospitals. The debate is still very much focused on whether consumers have access to certain doctors. According to the San Francisco Business Journal, the California Department of Managed Health Care has received at least 58 access complaints about their exchange plans since the start of the year.
The researchers said they plan to do a separate study looking at access to doctors in narrow network plans.
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But for now, the new study tamps down some of the early concerns that narrow network plans would mean greater problems with access to hospitals and potentially poor quality of care—at least in California.
The shift to more narrow networks was already happening before Obamacare—since narrowing provider networks is seen as a cost-saving mechanism for consumers. However, the ACA largely contributed to a greater push toward narrow networks in an even greater effort to control costs.
A study by McKinsey & Co. found that about 70 percent of plans sold on the ACA health exchanges last year contained limited networks, and their premiums were up to 17 percent cheaper than plans that had broader networks, Modern HealthCare noted.
Under the health care law, the administration laid out guidelines instructing insurers to include what they deemed enough doctors and hospitals to accommodate patients in a timely manner. However, some critics say the guidelines are too vague and ended up leaving the details up to states. Some states have passed legislation to increase these standards. According to the National Conference of State Legislatures, more than 70 bills have been introduced in 22 different states to better define network rules, Politico reported.
And though polls show that many Obamacare enrollees are satisfied with their plans, there are still concerns that narrow network plans may be detrimental to people seeking very specialized treatments.
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