WASHINGTON — Federal officials often say that health insurance will cost consumers less than expected under President Barack Obama's health care law. But they rarely mention one big reason: Many insurers are limiting the choices of doctors and hospitals available to consumers.
These insurers say that by restricting the number of providers who will treat patients in their new health plans, they are driving down premiums.
The insurance marketplaces open Oct. 1. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.
Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.
Consumers should be prepared for "much tighter, narrower networks" of doctors and hospitals, said Adam Linker, a health policy analyst at the North Carolina Justice Center, an advocacy group.
"That can be positive for consumers if it holds down premiums and drives people to higher-quality providers," Linker said. "But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network."
Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of providers.
Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas. "The networks will be narrower than the networks typically offered to large groups of employees in the commercial market," said Joseph Mondy, a spokesman for Cigna.
The current concerns echo some of the criticism that sank the Clinton administration's plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients' options, their access to care and their choice of doctors.