After the balky website is working, get ready for the next challenge under Obamacare: keeping your doctors and hospitals.
President Barack Obama once promised people could keep their doctors under the new health law. But in many states the new plans appear to offer fewer choices of hospitals and doctors than what consumers may expect. Also, it can be difficult to determine which medical providers are in what plans.
"The next shoe is going to drop sometime after Jan. 1, when people actually start using their plans," said health economist Gail Wilensky, who ran Medicare for President George H.W. Bush. "Whether or not they can keep their doctor is going to depend on whether their doctor was chosen — or wanted to be — part of a plan on the (insurance) exchange."
Why are the networks narrow? It's how insurers are keeping costs and premiums down. In fact, controlling networks is a trend that has emerged in other health plans unrelated to Obamacare as insurers struggle with mounting health care costs. For instance, in the Tampa Bay area AARP Medicare Advantage plans are not including Moffitt Cancer Center in their networks next year.
Technical problems with the website HealthCare.gov have dampened initial signups, but 7 million people are expected to participate in the insurance exchanges next year.
Exchange plans are required to take all applicants, cover broad benefits and provide robust financial protection against catastrophic illness. In return for that, something else has to give. The result: limited choices and significant out-of-pocket costs through deductibles and copayments.
"To get that low premium, the way to get there is by having a more limited or narrow provider network," said Matthew Eyles, a vice president of Avalere Health, a market analysis firm that is closely following developments.
Dr. Michael Wasylik, a Tampa surgeon who's active in managed care issues with Hillsborough Medical Association, said that with enrollments so low, it's too soon to say how local patients may be affected by network restrictions.
"There's not a lot of information because (so few patients) have signed up," he said.
Insurers have said their 2014 plans sold on the Marketplace will have the same networks as their "off-exchange" versions.
Networks differ according to insurer and plan. Florida Blue's low-premium "Blue Select" plans, for instance, include fewer hospitals than more expensive Blue plans. In Pasco, a patient with Blue Select will have only one local hospital — Pasco Regional Medical Center in Dade City — considered in-network.
A low-priced HMO plan from Humana would give a Hillsborough resident in-network access to Tampa General Hospital as well as Bayfront Medical Center in St. Petersburg — but not at hospitals owned by BayCare, the area's largest provider, nor at Moffitt Cancer Center.
The Obama administration says network restrictions won't detract from what will still be a historic improvement for uninsured people. Exchanges "will vastly increase uninsured Americans' access to providers, giving them an alternative to the emergency room or community health centers," said Health and Human Services Department spokeswoman Joanne Peters. The health care law sets standards for insurers to provide adequate networks, she added.
But the American Medical Association has questions.
"Although it may be too early to reach any definitive conclusions, we are monitoring the adequacy of the exchange networks and will be analyzing the impact of these restrictive strategies on patient access to care," said Dr. Ardis Dee Hoven, the organization's president.
Smaller states with fewer providers are feeling the pinch particularly. But large medical centers, too, are feeling the strain. In New York, one of the world's foremost cancer hospitals, the Memorial Sloan-Kettering Cancer Center, is not "in network" for any of the insurance plans on the state's exchange.
Avalere analyst Eyles said the health care law's narrow networks may gain acceptance if they are able to deliver quality care at lower cost. If that's the case, bet on more employer-based plans to adopt them.
As for finding out whether your doctor is on a plan, get ready to hunt. The federal marketplace serving Florida and 35 other states does not have a central online provider directory, said Robert Krughoff, president of Consumers' Checkbook, a ratings group. Instead it offers links to directories of individual plans.
"It's going to be a fair amount of work to go through and check each plan," Krughoff said.
Obama's promise, to a meeting of the AMA in 2009, evoked a simpler vision:
"No matter how we reform health care," the president said, "we will keep this promise to the American people: If you like your doctor, you will be able to keep your doctor, period. If you like your health care plan, you'll be able to keep your health care plan, period."
Information from the Associated Press and Times staff writer Jodie Tillman was used in this report.