Consumers who bought into the “ObamaCare will bend the cost curve downward” promise have had a tough year or so. First premiums shot upward, and deductibles did the same. Next, insurers sharply narrowed provider networks, forcing many consumers to pay out of pocket if they want to “keep their doctor,” as Barack Obama promised. Today, the Associated Press reports on another part of ObamaCare policy that may render insurance inadequate altogether — and consumers won’t know it until the bill hits:
You just might want to pay attention to the latest health insurance jargon. It could mean thousands of dollars out of your pocket.
The Obama administration has given the go-ahead for a new cost-control strategy called “reference pricing.” It lets insurers and employers put a dollar limit on what health plans pay for some expensive procedures, such as knee and hip replacements.
Some experts worry that patients could be surprised with big medical bills they must pay themselves, undercutting financial protections in the new health care law. That would happen if patients picked a more expensive hospital — even if it’s part of the insurer’s network.
The administration’s decision affects most job-based plans as well as the new insurance exchanges.
Other experts say reference pricing will help check rising premiums.
How does “reference pricing” work? It treats anything above the flat-rate limit covered by insurers as out-of-network costs, even if a patient is seeing a provider inside the network. Before ObamaCare, insurers would negotiate in-network prices for these procedures, and providers were forced to accept them as payment in full. Now providers will have much less incentive to agree to that kind of pricing structure, and instead go after the patients for the balance.
As if to rub salt in the wounds, the overage won’t count as out-of-pocket expenses. The Obama administration loudly insisted on such caps to protect consumers, and used those caps as proof that the ACA would keep Americans from facing bankruptcy over an illness. Reference pricing all but buries the caps, though. If a patient needed a $40,000 operation but the insurer only had a $30K reference price on it, the patient would have to cough up the other $10,000 plus all of the deductibles and out-of-pocket expenses otherwise under the cap. The AP notes this with some concern:
That’s crucial because under the health care law, most plans have to pick up the entire cost of care after a patient hits the annual out-of-pocket limit, currently $6,350 for single coverage and $12,700 for a family plan. Before the May 2 administration ruling, it was unclear whether reference pricing violated this key financial protection for consumers.
Some experts are concerned.
“The problem … from the patient’s perspective is that at the end of the day, that is who gets left holding the bag,” said Karen Pollitz of the nonpartisan Kaiser Family Foundation.
Yes, this is such an improvement over the system we had before.
Update: I literally had to stop what I was doing when I saw this on Twitter from Gabriel Malor:
— Gabriel Malor (@gabrielmalor) May 16, 2014
Er … yeah. I edited the paragraph in question.