Rep. Jared Huffman voices concerns about size of Obamacare physician networks

May 31, 2014

Rep. Jared Huffman says he is urging state insurance regulators and the head of California's health care insurance exchange to address concerns that the physician networks available under new Affordable Care Act insurance plans lack sufficient participating doctors.

"I am a big supporter of the Affordable Care Act. I think it is a really important reform," said Huffman, D-San Rafael. "But we have a lot more work to do to make it successful in the implementation."

Huffman said he wants to know, "How the heck did some of these very narrow and, in many cases, seemingly non-existent networks get approved by the state? Some of these networks never should have qualified to go onto the exchange; they are that bad."

Dr. Curtis Robinson, a family practice physician in Mill Valley and a member of Huffman's local medical advisory group, said, "It looks like in Marin and across the nation patients may not have any doctors to go to because of the insurance companies' aggressive contracting position to really lowball the doctors."

Robinson said several insurance companies that have signed up to participate in Covered California — the state's health care insurance exchange — are presenting contracts to doctors at approximately two-thirds of the Medicare fee reimbursement level, which is already quite low.

"That is what is going on right now in Marin, and I'm sure it's happening across the country," Robinson said. "It is going to put everyone out of business if they accept these contracts; the patients are not going to get the care they deserve."

Huffman said the physician networking issue pervades his district, and may be even more serious in rural areas. Huffman said that in Marin patients have the option of joining Kaiser Permanente. "In Eureka and other parts of my district," he said, "Anthem Blue Cross is 90 percent of the coverage."

In February, Marin Gastroenterology in Greenbrae, the county's largest gastroenterology practice with five doctors, and Marin Specialty Care, which includes nearly all of the county's oncologists, as well as a number of urologists, said they had turned down a contract offer from Anthem Blue Cross.

Contacted last week, however, Harvey Bichkoff, Marin Specialty Care's CEO, said his group has since signed a one-year contract with Blue Cross. Bichkoff declined to comment on the terms of the agreement. Marin Gastroenterology remains outside the Blue Cross network.

Patients having surgery at Marin General Hospital and Novato Community Hospital also have had trouble sorting out which medical groups assisting in the surgery — anesthesiologists, radiologists, testing laboratories and emergency physicians — are covered by their insurance.

Darrell Ng, a spokesman for Anthem Blue Cross, declined to comment on any ongoing contract negotiations with Marin doctors.

"Anthem has added 3,600 new doctors to our network in California," Ng said, "and we continue to look for doctors who are willing to partner with us to provide care for our exchange members."

Huffman said the size of the networks isn't the only issue; another problem is the accuracy of information provided about which doctors are in the networks.

There are several legislative initiatives in the works that address the networking issue. Huffman has signed on as a co-sponsor of HR 4077, a bill introduced by John Conyers, D-Michigan, and Dan Benishek, R-Michigan, that would provide limited antitrust exemption for physicians in negotiations with private insurance companies, giving health care providers more leeway to negotiate contract terms with insurers.

Robinson said, "It's a very important bill for physicians and patients." Robinson said doctors are prohibited from discussing their contract terms.

"There have been physicians who have been sued over discussing their contract with other providers," he said.

There are also two bills pending in the California Legislature. AB 2533, introduced by Assemblyman Tom Ammiano, D-San Francisco, would restrict higher charges for patients who go outside their insurance provider's network for medical care. And SB 964 would require the Department of Managed Care to survey insurers' physician networks for adequacy more frequently.

Anthony Wright, executive director of Health Access, a statewide health care consumer advocacy coalition, which sponsored SB 964, said there is nothing inherently wrong with insurers narrowing their networks to save money.

Wright said, however, "In return, the plan has to commit to providing enough doctors, enough hospitals

and enough specialists that you can get the care that you need in a timely manner."


Source: By Richard Halstead