The Las Vegas Review-Journal took a news article from its own newspaper out of context to mislead about insurance coverage and provider networks in Nevada under the Affordable Care Act (ACA).
In a September 19 editorial discussing new coverage options under the ACA, the Review-Journal suggested that people would be forced from their current provider networks onto streamlined "skinny networks," which would offer fewer doctor and hospital choices but would also cut health insurer costs (emphasis added):
President Barack Obama's 2009 guarantee was emphatic. "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 will be able to keep your health care plan. Period."
ObamaCare exchanges roll out in less than two weeks. The Patient Protection and Affordable Care Act -- or at least the portions of it the president deems politically expedient -- takes effect Jan. 1. And many Nevadans are about to learn the value of the president's word -- and get notice worthy of an exclamation-point tirade.
As reported by the Review-Journal's Jennifer Robison on Sept. 12, Nevada's insurers are expected to control the costs of dozens of coverage mandates by slashing the number of doctors and hospitals they contract with, creating what local employee benefits consultants call "skinny networks."
If you like your doctor, and your doctor isn't in your new skinny network, then guess what? You will not be able keep your doctor. Period.
But the editorial is misleading for several reasons. First, the Review-Journal article to which the editorial referred actually indicated that those who already have health coverage through an employer or their own business wouldn't see any coverage changes at all unless they elected to switch (emphasis added):
Whether you'll see a trimmed-down network in 2014 depends on your current coverage. If you have a policy through a big company or a self-insured business, and you don't change plans Jan. 1, your network should stay the same. If you have to change plans, or if you're buying for the first time, you could see thin networks.
For carriers who offer them, skinny networks save money two ways. First, with fewer providers, consumers won't seek as much care. If the closest hospital in your network is 20 minutes away, you're less likely to make an unnecessary trip to the ER, for example. So the networks cut patient-use rates.
They also let insurers carve out the priciest providers. One carrier told Caparso a heart procedure that costs $19,000 at one local hospital runs $43,000 at another. With a skinny network, that carrier can offload the more expensive hospital and cut its reimbursement exposure by more than half.
The editorial also promoted the false claim that insurance rates "have to go up" under the ACA. However, a new report by the Department of Health and Human Services shows that premium prices are expected to be 18 percent lower than previous 2014 projections:
In the eleven states for which data are available, the lowest cost silver plan in the individual market in 2014 is, on average, 18% less expensive than [Assistant Secretary for Planning and Evaluation's] estimate of 2014 individual market premiums derived from CBO publications.
Lastly, the Review-Journal's editorial used common conservative scare tactics to stoke fears about fraud in the federal subsidies for health coverage. In fact, the Congressional Budget Office released a report on September 10 showing that income verification procedures are already in place to ward off potential fraud, and will be ready for the January 1 launch. As CNN reported, those applying for federal financial aid under the exchanges will have their incomes verified against federal records:
Exchanges must still check the applicant's income against a federal database, which will include information from his federal tax returns and a record of Social Security benefits.
The exchanges will be looking for disparities between what the applicant says and what's in the database.
If it looks like someone is understating his income by more than 10%, and the exchange doesn't have other sources to quickly check against, the exchange may choose to rely on what the applicant says.
But in those cases, the exchange must also conduct a random sample of similar applicants to make sure the verification process is working.