Lower health insurance premiums to come at cost of fewer choices
Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H., said his hospital had been excluded from the network without any discussions or negotiations.
"Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals," Mr. Gosline said. "It's very inconvenient for patients, and at times it's a hardship."
State Senator Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said, "The people of New Hampshire are really upset about this."
Many physician groups in New Hampshire are owned by hospitals, so when an insurer excludes a hospital from its network, it often excludes the doctors as well.
David Sandor, a vice president of the Health Care Service Corporation, which offers Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, said: "In the health insurance exchange, most individuals will be making choices based on costs. Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals."
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Premiums will vary across the country, but federal officials said that consumers in many states would be able to buy insurance on the exchange for less than $300 a month — and less than $100 a month per person after taking account of federal subsidies.
"Competition and consumer choice are actually making insurance affordable," Mr. Obama said recently.
Many insurers are cutting costs by slicing doctors' fees.
Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were "often below our cost of doing business, and definitely below commercial rates."
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Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.
Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.
"If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors," said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. "Some insurers do not want those patients who, for medical reasons, require a broad network of providers."
—By Robert Pear of The New York Times