California hospital networks are narrower in marketplace than in commercial plans, but access and quality are similar

Health Affairs

Volumn 34, Issue 5, 2015, Pages 741-748

  Haeder, Simon F ^a   Weimer, David L ^a   Mukamel, Dana B ^b  

^a UNIVERSITY OF WISCONSIN MADISON   (United States)

^b UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; HEALTH INSURANCE; HOSPITAL; HOSPITAL CARE; HOSPITAL MANAGEMENT; HUMAN; MARKETING; QUALITY CONTROL; TRAVEL; UNITED STATES; CALIFORNIA; COMMERCIAL PHENOMENA; COMPARATIVE STUDY; COST CONTROL; ECONOMICS; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE POLICY; HEALTH CARE QUALITY; HOSPITALIZATION; ORGANIZATION AND MANAGEMENT;

CALIFORNIA; COMMERCE; COST SAVINGS; HEALTH INSURANCE EXCHANGES; HEALTH PLAN IMPLEMENTATION; HEALTH SERVICES ACCESSIBILITY; HOSPITALIZATION; HUMANS; PATIENT PROTECTION AND AFFORDABLE CARE ACT; QUALITY OF HEALTH CARE; STATE HEALTH PLANS;

EID: 84929612598     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2014.1406     Document Type: Article

References (33)

1. Haeder SF. Beyond path dependence: explaining healthcare reform and its consequences. Policy Stud J. 2012;40(Suppl 1):65-86.
2. Haeder SF, Weimer DL. You can't make me do it: state implementation of insurance exchanges under the Affordable Care Act. Public Adm Rev. 2013;73(Suppl 1):S34-47.
3. Karlamangla S. California says 14,500 must redo Obamacare applications after glitch. Los Angeles Times [serial on the Internet]. 2014 Feb 28 [cited 2015 Mar 12]. Available from: http://articles.latimes.com/2014/feb/28/business/la-fi-momalfunction-redo-coveredcalifornia-apps-20140228
4. Terhune C, Karlamangla S. California website for Obamacare back up after 5-day outage. Los Angeles Times [serial on the Internet]. 2014 Feb 24 [cited 2015 Mar 12]. Available from: http://articles.latimes.com/2014/feb/24/business/la-fi-mohealth-exchange-website-20140224
5. Cadelago C. California voters' support for health care law inches up. Sacramento Bee [serial on the Internet]. 2014 Aug 19 [cited 2015 Mar 12]. Available from: http://www.sacbee.com/news/politicsgovernment/article2607041.html
6. Viebeck E. Calif. beats Obamacare sign-up goal weeks early. The Hill [serial on the Internet]. 2014 Feb 19 [cited 2015 Mar 12]. Available from: http://thehill.com/policy/healthcare/198744-calif-we-beat-o-careenrollment-goal
7. Metz D, Strimple G. Findings of a statewide survey on expanding access to health coverage [Internet]. Los Angeles (CA): California Endowment; 2014 Sep 30 [cited 2015 Mar 12]. Available from: http://www.calendow.org/uploadedFiles/Health_Happends_Here/FM3-GS_Strat-Final%20Memo.pdf
8. NAIC Health Insurance and Managed Care (B) Committee. Plan management function: network adequacy white paper [Internet]. Kansas City (MO): National Association of Insurance Commissioners; 2012 Jun 27 [cited 2015 Mar 12]. Available from: http://www.naic.org/documents/committees_b_related_wp_network_adequacy.pdf
9. Center for Consumer Information and Insurance Oversight. 2015 letter to issuers in the federally-facilitated Marketplaces [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; 2014 Mar 14 [cited 2015 Mar 12]. Available from: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2015-finalissuer-letter-3-14-2014.pdf
10. McCarty S, Farris M. ACA implications for state network adequacy standards [Internet]. Princeton (NJ): Robert Wood Johnson Foundation; 2013 [cited 2015 Mar 12]. Available from: http://www.rwjf.org/en/library/research/2013/08/aca-implications-for-state-networkadequacy-standards.html
11. Enthoven AC, Singer SJ. The managed care backlash and the task force in California. Health Aff (Millwood). 1998;17(4):95-110.
12. Norman B. Obamacare: anger over narrow networks [Internet]. Arlington (VA): Politico Pro; 2014 Jul 22 [cited 2015 Mar 12]. Available from: http://www.politico.com/story/2014/07/obamacare-health-carenetworks-premiums-109195.html
13. Demko P. Nearly half of exchange products offer narrow networks, McKinsey study says. Modern Healthcare [serial on the Internet]. 2014 Jun 10 [cited 2015 Mar 12]. Available from: http://www.modernhealthcare.com/article/20140610/blog/306109998
14. Klein P. Regulators struggle with Obamacare's narrow networks problem. Washington Examiner [serial on the Internet]. 2014 Sep 8 [cited 2015 Mar 12]. Available from: http://www.washingtonexaminer.com/regulators-struggle-withobamacares-narrow-networksproblem/article/2552849
15. Ngai EYC. California insurance commissioner issues emergency regulations affecting narrow provider networks [Internet]. Western Springs (IL): National Law Review; 2015 Jan 12 [cited 2015 Mar 12]. Available from: http://www.natlawreview.com/article/californiainsurance-commissioner-issuesemergency-regulations-affectingnarrow-prov
16. AIS Health. Inside health insurance exchanges: exchange briefs. 2014; 4(7):7-8.
17. "Any willing provider" laws at the very least require carriers to enter into network negotiations with providers seeking to join their networks. Stricter forms require carriers to accept providers into their networks if they accept their rates and conditions. "Freedom of choice" laws allow consumers to seek treatment from providers outside their carrier's network. For details, see Corlette S, Volk J, Berenson RA, Feder J. Narrow provider networks in new health plans: balancing affordability with access to quality care [Internet]. Washington (DC): Georgetown University Health Policy Institute; 2014 May [cited 2015 Mar 12]. Available from: http://www.urban.org/UploadedPDF/413135-New-Provider-Networksin-New-Health-Plans.pdf
18. We also note that carriers may have restricted networks outside of the Marketplace, as has been the case in several other states (see Note 19). However, we have no evidence that this occurred in California, and the lack of newspaper coverage on the topic may indicate that this was not the case. Our analysis here focuses on the comparison between commercial and Marketplace networks for 2013-14 only.
19. Cox C, Ma R, Claxton G, Levitt L. Sizing up exchange market competition [Internet]. Menlo Park (CA): Henry J. Kaiser Family Foundation; 2014 Mar 1 [cited 2015 Mar 12]. Available from: http://kff.org/health-reform/issue-brief/sizing-upexchange-market-competition/
20. Note that from here on forward, we combined the two Los Angeles County regions, 15 and 16, into one region.
21. For commercial plans, percentages range from 45 percent to 100 percent with a mean of 86 percent (standard deviation 15 percentage points) and a median of 88 percent.
22. To access the Appendix, click on the Appendix link in the box to the right of the article online.
23. Garnick DW, Luft HS, Robinson JC, Tetreault J. Appropriate measures of hospital market areas. Health Serv Res. 1987;22(1):69-89.
24. Robinson JC. Hospital tiers in health insurance: balancing consumer choice with financial motives. Health Aff (Millwood). 2003;22:w3-135-46. DOI: 10.1377/hlthaff.w3.135
25. Enthoven AC, Schauffler HH, McMenamin S. Consumer choice and the managed care backlash. Am J Law Med. 2001;27(1):1-15.
26. Cuellar AE, Gertler PJ. How the expansion of hospital systems has affected consumers. Health Aff (Millwood). 2005;24(1):213-9.
27. Corlette S, Lucia K, Ahn S. Implementation of the Affordable Care Act: cross-cutting issues: six-state case study on network adequacy [Internet]. Washington (DC): Urban Institute; 2014 Sep [cited 2015 Mar 12]. Available from: http://www.rwjf.org/content/dam/farm/reports/reports/2014/rwjf415649
28. AIS Health. Narrow networks: HMO redux or effective rate-reducing strategy? Inside Health Insurance Exchanges. 2013;3(4):4-5.
29. Morrisey MA. Competition in hospital and health insurance markets: a review and research agenda. Health Serv Res. 2001;36(1 pt 2):191-221.
30. National Committee for Quality Assurance. Network adequacy and exchanges [Internet]. Washington (DC): NCQA; 2013 [cited 2015 Mar 12]. Available from: http://www.ncqa.org/Portals/0/Public%20Policy/Exchanges&NetworkAdequacy_2.11.13.pdf
31. Noble A. Insurance carriers and access to healthcare providers: network adequancy [Internet]. Washington (DC): National Conference of State Legislatures; 2014 Nov 30 [cited 2015 Mar 12]. Available from: http://www.ncsl.org/research/health/insurance-carriers-andaccess-to-healthcare-providersnetwork-adequacy.aspx
32. However, the case against managed care was much broader, including concerns about physician autonomy, executive compensation, and administrative costs, among other things, and not solely as a result of narrow provider networks.
33. Hacker JS. The road to nowhere: the genesis of President Clinton's plan for health security. Princeton (NJ): Princeton University Press; 1997.