Tom Coburn: My new ObamaCare coverage won't cover treatment from my cancer specialist

Via the Free Beacon, a vivid illustration of how the Affordable Care Act keeps coverage “affordable.” All you need to do is exclude the pricier doctors and hospitals, like Cedars-Sinai in L.A. and Sloan Kettering in New York, from a plan’s provider network, and voila — savings.


The top lobby group for US health insurance plans, America’s Health Insurance Plans, said the new healthcare law brought “new costs” to the industry and that selecting hospitals and physicians that meet “quality standards” was one way of making health plans more affordable for consumers.

But Mr Priselac at Cedars-Sinai in Los Angeles says the creation of ever more narrow provider networks by insurers is being driven by price alone, and not by quality. He says the hospitals that are being excluded are leaders in innovation, which saves billions of dollars for the healthcare system in the long run.

Coburn didn’t reveal who his doctor is, but needless to say, losing your doctor is not an uncommon experience in the new golden age of “universal” health care, even for cancer patients.

The Oklahoma Republican’s spokesman confirmed to POLITICO that since the senator enrolled in his health insurance plan under Obamacare, his coverage has been reduced and he lost coverage for his cancer specialist. Coburn will continue to pay out of his own pocket and see the oncologist, his office said…

“We hope the White House will work with us to make sure Americans who can’t afford to pay out of pocket don’t lose access to life-saving care,” spokesman John Hart said. “As Dr. Coburn’s experience shows, the American people are about to learn they’re going to lose access to not only their doctors and plans, but their specialists and treatments.”

Have provider networks shrunk that much even among “gold” and “platinum” plans on the exchanges? That’s what Coburn, who’s already survived previous bouts with cancer, would have purchased, I assume. It’s no secret that “bronze” and “silver” plans help pay for their lower premiums by keeping provider networks comparatively small; I assumed one of the benefits for shelling out for a cadillac plan would be a robust network. Not robust enough, apparently.

If you missed it in Headlines yesterday, read Philip Klein’s critique of Coburn’s proposed alternative to ObamaCare. It’s not a wholly new paradigm so much as an overhaul of O-Care itself — higher premiums for the old to provide relief to the young, coverage for preexisting conditions only if the insured has maintained continuous coverage, retaining the employer health insurance tax exclusion (albeit with a cap), and so forth. My sense of it is that it’s not meant as a permanent Republican replacement for O-Care but rather as a proposal that might attract centrist Democrats in the short-term. Get Democrats to accept a more liberalized version of ObamaCare now and then try to build on that to open them up to more ambitious reforms later.