Are quality and choice sacrificed in health-care exchanges?



By now, everyone’s heard of the health insurance exchanges, created as part of President Obama’s Affordable Care Act. In theory, they’re supposed to make health insurance available for people who previously could not afford insurance, who were not insured because
of pre-existing conditions or
were not offered workplace coverage.


TO SAY THERE is a lot of confusion surrounding these exchanges and their implementation is an understatement. There have been reported delays in accessing the exchanges on federal websites, and no one within the federal government can give an accurate count of how many people have signed up for insurance through the exchanges.

In Augusta, two insurance companies have entered the exchange market: Blue Cross Blue Shield and Humana.

First, to avoid further confusion: University Hospital is a BCBS provider for all of its commercial products, including products offered to active members of the State Health Benefit Plan. However, University was informed Oct. 11 that it was not included on the public exchange product offered by BCBS. University was the only Augusta hospital excluded despite being recognized as the sixth-ranked hospital in the state for quality by U.S. News & World Report. And University is not alone – eight of the top-10 hospitals in Georgia were excluded from the BCBS network.

What this means is a narrowing of consumer choices all over the state, including Augusta. In addition to our U.S. News & World Report quality ranking, University has been named the National Research Corporation Consumers’ Choice Award winner for overall quality for 15 years in a row. We also hold the Blue Cross Blue Shield Distinction Center Plus recognition in hip replacement, knee replacement and spine surgery, signifying we have displayed great expertise and efficiency in these areas. These are just a few of many quality distinctions we hold throughout the region.


THERE IS NO question that University is a quality leader when it comes to taking care of our patients. We believe new enrollees on the exchange should have access to the same level of care our community has become accustomed to receiving from University.

There were no negotiations with BCBS or discussions with us regarding rates. When we called to ask if we could be included in the network, we were told that the exchange had been set for the next year. This represents a total departure from the relationship we have had with BCBS in the past. If this is a glimpse of the future under the new Affordable Care Act, we all should plan on narrower choices of providers with little regard for quality.

The good news – if there is any here for those who would prefer University – is that Humana’s public exchange includes University Hospital in its network, and according to its family premium is priced significantly less expensive ($595.16 for Humana, vs. $718.64 for BCBS coverage—a 20.7 percent difference).


THE IMMEDIATE impact of the creation of these exchanges has been a narrowing of choices for consumers. For patients in our community currently enrolled in BCBS commercial products, University remains a network provider. For those who are making choices on the new public exchange, the BCBS option has narrowed your choices and excluded the community’s top quality provider.


(The writer is chief executive officer and president of University Health Care System in Augusta.)



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