Limited health networks undo the good of Obamacare

Health insurance companies, like Anthem, are empowered to pick winners and losers among hospitals like ours


Published:

The beginning of the admission period for Obamacare is a legitimate cause for celebration for anyone who has not been able to afford health care coverage until now, and for those who are seeking ways to reduce the cost of their insurance.

But as many people line up to join the health insurance system, the door is slamming shut for many providers of health care in New Hampshire and around the country. This is already having dramatic impact on the relationship between doctors and patients.

It is critical to remember one reality about this reform: Obamacare means roughly 10 million people will now be enrolled in health care programs around the country. But there is no plan to expand the number of doctors or health care providers to handle the sudden surge of new patients in the system.

In fact, the opposite is happening in New Hampshire because of the limits written into the law. Health insurance companies, like Anthem, are empowered to pick winners and losers among hospitals like ours. They draw up the insurance coverage options for you to consider, and Anthem then enters into partnerships with hospitals of its choosing. The insurance companies are the authors of the plans, from which they will make a profit. And the insurance companies choose which facilities will take their customers.

In New Hampshire, Frisbie Memorial Hospital, Alice Peck Day Memorial in Lebanon, Cottage Hospital in Woodsville, Monadnock Community Hospital in Peterborough, Parkland Medical Center in Derry, Portsmouth Regional Hospital, Upper Connecticut Valley Hospital in Colebrook and Valley Regional Hospital are all excluded from this program. That has a tremendous and crippling impact on the way health care will be provided in our state.

At Frisbie, there are 80 health care providers who care for nearly 7,000 patients who don’t have insurance and will be eligible for coverage through Obamacare. However, those people will have to go to Dover for care. That is the sudden and unexpected split in doctor/patient relationships that have been in place for many years. That is a loss of choice for patients, a crippling loss of business for providers, and it jeopardizes the future of how we provide health care in our own community.

The goals of this program are admirable, but when you have a proposal that will essentially bring thousands of new patients into the system, but you severely limit the access to care by excluding so many of us from the provider network, you threaten the efficiency and quality of the system.

What will be the result? Patients will need to build new relationships with new doctors outside of their communities. More people bottlenecked into fewer facilities will increase wait times for everything from regular doctor visits to receiving test results to being scheduled for various procedures all around New Hampshire. Lines get longer, doctors in the network deal with a much heavier load, and many providers like the doctors and nurses and specialists at Frisbie Memorial will watch from the sidelines.

That makes no sense, but there is an answer.

Anthem can open the door to the hospitals that have been excluded. They can take proper steps to protect existing doctor-patient relationships that are now being ripped apart. They can do the appropriate thing to ensure access to care is the priority, not profits.

State leaders need to ensure more balance in the decision process around this program. If one side has too much power, the balance between access, affordability and quality is threatened. That’s happening right now. The goals of Obamacare are noble. But this plan will forever change the face of health care in New Hampshire, and it won’t be an improvement.

Al Felgar is president and CEO of Frisbie Memorial Hospital in Rochester.

Edit ModuleShow Tags