The Affordable Care Act: What’s the latest?

Professional societies are taking note
Today, the misuse of narrow networks by exchange plans also has gotten the attention of the American Medical Association, ACOG, and many other national medical specialty societies, in addition to the states and federal government.

The trick, many health-care policy experts agree, is to find the right balance. How broad can the network be before premiums soar? Most agree that consumers must be able to choose between plans with confidence, without any cost or access surprises, meaning much better transparency. And many agree that provider quality, in addition to cost, has to find its way into the equation.

This year, the Center for Consumer Information and Insurance Oversight, a part of the federal Department of Health and Human Services created by the ACA to investigate these kinds of issues, is investigating access to hospital systems, mental health services, oncology, and primary care providers and is developing time, distance, and other standards that insurers will have to adhere to.

Employer groups oppose strong standards or limits on narrow networks. Recently, representatives of the US Chamber of Commerce, the ­National ­Retail Federation, and others warned ­Congress to stay out of this fight. They understand that more generous networks mean higher premiums. These employer representative groups prefer to strengthen consumer protections like directories and keep low the cost of health insurance that they provide for their employees.

Acknowledgment
The author acknowledges the work and expertise of ACOG's state government affairs team for the state analysis—Kathryn Moore, Director, and Kate Vlach, Senior Manager—as well as advocacy partners.

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