If you’re heading to the Minnesota State Fair this week, it will be difficult to miss the massive billboard on Snelling Avenue encouraging Minnesotans to boycott MNsure, the state’s new health insurance exchange.
The billboard is paid for by the Citizens' Council for Health Freedom, a group that opposes the federal health care law, and asks “Why can’t I choose my own doctor?”
Buying a plan through MNsure will not prevent you from choosing your own doctor.
MNsure is an online marketplace where consumers and small businesses will be able to purchase health insurance. People can also use it to enroll in government programs like Medicaid. Most people in Minnesota have insurance through their employer, so they won’t be using MNsure.
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The site opens on Oct. 1, 2013, and the state’s commerce department is in the final stages of approving plans to be sold on MNsure. The exchanges are a cornerstone of the Affordable Care Act and are designed to let people compare plans and choose the coverage that’s best for them.
Asked about the suggestion that MNsure will prevent people from choosing their own doctor, CCHF spokesman Mike Hamilton argues a slightly different point—that the provider network of the plan you choose may be so narrow, it excludes your current or past doctors.
“The chances of you getting a plan that’s qualified under the state exchange that has the doctors that you have or that have already covered you is possible but it’s definitely not guaranteed,” said Mike Hamilton, a spokesman for the Council.
He pointed to a recent article in the Wall Street Journal that looked at how exchange participants in other states have limited their plan networks to hold down cost.
A McKinsey & Co. study that’s scheduled for publication in the fall found that 47 percent of the insurance plans filed on other state exchanges are HMOs or plans that will cover visits to a limited roster of providers, according to a firm spokesperson.
That’s the case in California, for instance, where the highly ranked Cedars-Sinai Medical Center in Los Angeles won’t be included in some networks.
University of Minnesota public health professor Jean Abraham says defined networks are a trend throughout the industry, whether you get your coverage through your employer or on the individual health plan market. And it may be true of the plans sold through MNsure, too. But that won't become clear until the plans are made public in the next few weeks.
Narrowing networks puts insurers in a better negotiating position with doctors and hospitals because the insurers can promise them more business-- more of their enrollees will come to those providers.
“It’s a trade-off of breadth of providers from which to choose versus cost,” Abraham said.
But does that mean you won’t be able to choose a doctor if you buy a plan through MNsure?
Abraham says no.
“No one is going to assign you a doctor,” she said.
It’s possible that some people who buy insurance on the individual market now will have trouble finding an exchange plan that includes their current doctor, said Marian Mulkey, director of health reform and public programs initiatives at the California HealthCare Foundation. But most people using the state marketplaces probably don’t have coverage and don’t have a steady relationship with a single doctor, she said.
It’s true that insurers participating in other state exchanges have crafted plans that feature defined networks to keep costs low for consumers.
But there are big flaws with the Council’s billboard.
First, we don’t know anything about the plans that will be sold on MNsure, so it’s impossible to say whether they will be narrow or not. By state law, those details are secret until Sept. 6.
And even if plans sold through MNsure include narrow networks, that doesn’t mean buyers can’t choose their doctors.
“To say you have no choice is certainly false,” said Mulkey. “You’ll likely have lots of choice and lots of ability to select among a broad provider network, but perhaps not universal choice.”
In fact, it’s rare that people who get their insurance through employers can choose any doctor they want and the exchanges are no different, Mulkey added
The Council’s claim is misleading to the point of being false.
Citizens Council for Health Freedom, CCHF’s ‘Refuse MNsure’ Billboard Campaign Launches at Minnesota State Fair, August 12, 2013
MNsure, accessed Aug. 21, 2013
The Wall Street Journal, Many Health Insurers to Limit Choices of Doctors, Hospitals, by Anna Wilde Mathews
LA Times, Insurers limit doctors, hospitals in state-run exchange plans, by Chad Terhune, May 24, 2013
Interview, Jean Abraham, Associate Professor, University of Minnesota, School of Public Health Division of Health Policy & Management
Interview, Marian Mulkey, Director of Health Reform and Public Programs Initiatives, California HealthCare Foundation
Email exchange, Emily Hackel, spokesperson, McKinsey & Co.