OUR state has been praised for being a leader in expanding health-insurance coverage for its citizens. It is important, however, to keep in mind that having insurance does not necessarily equate to having access to health care. As we consider expanding Medicaid under the federal Affordable Care Act, we face the question, “Will there be enough physicians in the new networks to treat newly insured patients?”
The Washington State Medical Association is concerned that current requirements for achieving network adequacy may allow health-insurance products to be offered where there are not enough doctors. This certainly would not benefit patients’ access to care.
To take a step back, Washington state is a national leader in developing a health-benefit exchange. Exchanges are new organizations being developed to create a more organized and competitive market for buying health insurance — like Expedia or Amazon.com for health insurance. Exchanges will offer consumers a choice of different health plans and provide information to help them better understand their options. Washington Healthplanfinder, the name given to our state’s online health-insurance marketplace, will start enrolling consumers on Oct. 1 for health-insurance coverage beginning on Jan. 1, 2014, and will primarily serve individuals buying insurance on their own, as well as small businesses with up to 100 employees.
If the state expands Medicaid under the federal Affordable Care Act, subsidized health-plan options will become available to those consumers whose incomes fall between 133 percent and 400 percent of the federal poverty level. It’s estimated that 532,000 Washingtonians would be eligible for those subsidized plans through our state’s Exchange and that 344,000 people in our state are likely to take advantage of the program by the end of 2014. By 2017, that number could grow to over 470,000.
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This is all good news, right? Maybe not. The 344,000 patients newly acquiring health insurance in 2014 will need physicians to care for them. However, there is a concern that health-insurance plans in the exchange may not be able to sign up enough doctors and other caregivers to provide that care. Currently, health plans are reaching out to physicians about participating in their exchange products, which will be available through the Washington Healthplanfinder.
Physicians who participate in any network generally have a mix of the types of patients and insurance products they accept in order to maintain the viability of their practices. It’s not guaranteed physicians will participate in these new exchange products, but we must have regulations in place to ensure that products are only offered if they in fact have adequate networks of physicians who are actually taking new patients. If there are not enough physicians and other providers available in the plans, our state’s exchange could fail to meet its overall objective of improving access to affordable health care.
Washington physicians are committed to improving access to care for patients. So it is important that policymakers and health plans ensure that physician capacity is adequate to serve all of the patients needing care. Simply counting the number of physicians and the number of patients is not an adequate measure of access.
To address this concern, the state must review the relevant laws and regulations on network adequacy with a goal of setting standards that assure patients’ access to providers. The state should establish requirements not just for the number of providers but the number of providers who are actually accepting new patients, and the capacity of those providers to see new and existing patients in a timely manner. It is one thing to say that more people are insured, it is quite another to say that more people are able to be seen and treated by a physician in a timely manner.
We must not lose sight of our ultimate goal in creating the exchange: to improve patients’ access to the best possible medical care.
Nick Rajacich is president of the Washington State Medical Association. He is board certified in orthopedic surgery.