When Obamacare crossed its projected 7 million enrollment mark and attained the shining figure of 8 million enrollments, the administration was not aware of a storm these enrollments would kick up in the near future. As soon as these enrollees started utilizing their health insurance, they were faced with a harsh reality – their health plan did not have their preferred doctors, hospitals or the right combination of both. The new enrollees were at a loss, and ultimately had to pay out of pocket for services and providers that were not covered by their plan.
The question slowly turned into that of honoring the promises made by the administration while pushing these plans to Americans. With broken promises and narrow networks, the administration faced the ire of unsatisfied consumers. Gradually, this challenge became a top priority for the administration, and it seems that the administration is coming closer to resolving the issue. As a result of this ACA overhaul, the states have taken it upon themselves to upgrade their rules that affect insurance networks. This upgrade will help states better determine coverage status, healthcare shopping and benefit usage by residents.
Most states had laws to ensure that consumers were given satisfactory access to primary care providers and specialty physicians by health plan networks. Now, with the changes brought by the ACA, the states are improving these rules to address issues, such as where and how people access healthcare. A good example of this is the change in primary care providers, with nurse practitioners and physician assistants providing primary care services to patients. Also, patients have started using emergency rooms instead of relying on the traditional methods of scheduling an appointment with the doctor. The focus is moving to the type of services provided from the type of providers participating in care.
States do not want to come out as inept in handling consumer complaints of insufficient access to healthcare, and that’s why most of them are moving to a new rule set that will handle these anomalies in the process. States also want to consider the cases where health providers have showed that their specialty products aren’t fully represented on the marketplace or by navigators who helped people enroll with the system. Most states are looking for an all-round approach that will allow them to appease the consumers and make the health plans more compliant. Arkansas, California, Minnesota and Washington are some states which have already started revamping their health care rules to better aid Americans under Obamacare.
However, the state’s plan has certain inherent challenges that are slowing down the rollout. A common challenge across all states is that the quick implementation of ACA cannot be matched by states in their healthcare rule overhaul. Additionally, it is going to take some time before states have an answer to the concerns raised by new enrollees. The regulations across states are different, and each state needs a special strategy that addresses their problems. For instance, Washington has enacted a new set of rules that provides detailed information to consumers on the networks of plans they want to enroll in. Health plans are required to show detailed geographical information that depicts their ability to meet the needs of all their enrollees and to guarantee adequate care to consumers. This move came after several new enrollees complained that their new health plan did not have their preferred doctor or hospital. Similarly, Minnesota thinks that it is running on outdated rules and MNinsure and the Department of Health need to work out a new set that is relevant to the current times. At the same time, states are encouraging health insurers to reduce the liability on consumers by innovating to control rising healthcare costs that are affecting the quality and strength of the coverage network. Most states are working their rules to address cost, coverage, and transparency while choosing health plans.
In a nutshell, the ACA has set the stage for not only providing better health insurance to consumers but also improving the healthcare rules currently operating across the country. By the time the dust settles around the law’s implementation, we will have a closely coordinated system that will work to provide better healthcare to American citizens.