PoliGraph: MNsure won’t block you from choosing your doctor

poligraph-falseIf 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.

The Evidence

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.

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.

The Citizens’ Council for Health Freedom is on Snelling Ave. outside the 2013 Minnesota State Fair. (Courtesy of Citizens’ Council for Health Freedom.)

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.

The Verdict

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.

SOURCES

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.

 

  • Sara Amaden

    How can you spend the majority of your article explaining why we might not be able to choose our own doctor and then conclude that the billboard is false?
    How do you expect to retain credibility with such a mystifying interpretation of your own reporting?

  • Tonto

    Richert should be embarrassed. She parses out choosing A doctor from choosing your OWN doctor (as the billboard clearly states). Disingenuous, but typical. Don’t we also fund these lies with our money …against our will?

    The billboard must make MPR very nervous, but they should try to be honest for a change. Next time they shouldn’t pick their friends at the University of Minnesota to be arbiters of truth.

  • RichardOwens

    The billboard is propaganda. It misleads and plays on fear and ignorance.
    We in Minnesota are so very fortunate to have progressive, high quality healthcare institutions and political leaders.

    The rate of rising costs of healthcare BEFORE the ACA was ruining our economy and not returning good health outcomes.

    Shame on the GOP and their incessant negativism and refusal to offer anything constructive. The “free market” they say will fix everything has already failed 25% of us American citizens.

    • Steve

      Our system did not fail. If you do not work, are not a citizen or you just plain choose not to buy insurance you don’t have it. I do a lot of work in the hospitals and I often (very often like every day) see people come in — first they drive there so they can afford a car, they have on Nike and Adidas clothes they get out their IPhone to make a call, then go out side have a smoke and come back in to say “I don’t have any insurance”. So put that in you pipe and smoke it. Why can’t people like you wake up —- is it really societies responsibility to take care of you. If you injured or sick yes we can help you but if your not find a way to get your own insurance and don’t mess with mine—- I happen to like working and paying for what I get.

  • Steve

    Richard Owens
    Shame on you – you start out saying we are “fortunate to have progressive, high quality healthcare institutions” already in this state — then you try to turn your argument into saying that if we don’t want to change those high quality institutes we are wrong. This is typical liberal bs ——— if we don’t like your system we are wrong but if we don’t like your system you say it is unfair. Wake up and pay your own way — you are just looking for a hand out from “Big Brother”

    • RichardOwens

      If you have facts, then put them out here. The billboard is PROPAGANDA.

      The GOP has incessantly demogogued this issue until most people don’t even know what the ACA DOES.

      25 million people without insurance and what? You don’t see a problem?

      It’s not all about YOU.

  • RichardOwens

    Steve- regarding your “typical liberal bs” and “looking for a hand out..”

    Your insults directed to me are wrong. I have paid for all my health insurance and carried a $2K deductible for years, and PAID IT ALL as I am self-employed. Your remark angers me.

    My sentiments are directed to the millions of Americans (some of whom I know) who have been wiped out financially by a catastrophic health event in their family, or were refused care due to a “pre-existing condition”.

    I’ve been to too many benefits for kids and adults alike whose family couldn’t pay their bills from huge hospital bills they couldn’t avoid.

    Why were you offended by my remarks?

  • IBNNNEWS

    This is MPR liberal fodder. MNSure has proven beyond a doubt they are a bigoted, racist and antiquated organization.

  • Ryan Gustafson

    Billboard says X. X is true. Billboard is false.

    Logic.