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The Next Shoe to Drop: Will your Doctor be in your Network?

By Dr. David C. Pate, News and Community
April 8, 2014

Editor’s note: A version of the article that follows originally appeared as a column under a different headline in the Idaho Statesman’s Business Insider.

President Obama made repeated promises before, during, and after signing his landmark Affordable Care Act into law. One of those promises was that if you like your health care plan, you can keep your health care plan.

When hundreds of thousands of people recently began receiving notices that their health plans were being terminated because they did not comply with ACA requirements, the president had to face angry Americans and anxious Democrats facing re-election.

With news media repeatedly repeating his earlier assurance, he did what a leader should do: He apologized and pledged to regain public trust.

Continued divisiveness regarding his signature health care reform law, plummeting poll numbers, a botched rollout of the highly touted healthcare.gov health insurance marketplace, and the recent admission that statements about keeping your health plan were, at best, misleading have certainly been setbacks to the Obama administration.

The healthcare.gov website was improved, and it is possible there will be greater support for the ACA now that more people are insured, especially if premiums do not skyrocket in the fall, when insurers reset rates after this initial year of a hard-to-predict risk pool of newly insured members.

However, there is another shoe to drop. At the same time the president and other Democratic leaders made assurances regarding health care plans, they also told Americans that if they liked their doctors, they’d be keeping their doctors.

For many Americans, that will not turn out to be true. This is not because of requirements in the ACA, but rather insurers’ response to the ACA. It’s also not the design of the ACA, as was the issue relating to whether health care plans would qualify as of 2014, but the narrow networks that are emerging in response to the pressing need to reduce healthcare spending.

The ACA shifts a lot more risk to insurers, who now have to cover everyone regardless of pre-existing illnesses. The law prescribes a rich packet of benefits.

Many have predicted that younger, healthier people would be reluctant to buy insurance, which insurers count on to help subsidize the costs for older and sicker participants. To respond to the cost pressures, insurance companies are creating narrow networks and obtaining price concessions from hospitals and physicians in return for greater numbers of patients.

These are natural and necessary responses of the market to cut costs. And in this case, the outcry will not be a consequence of the president’s doing, but will become a problem for him because he went out on a limb and promised the American people that they could keep their doctors.

It’s one thing to change plans. It is an entirely different matter to have to change doctors. My prediction is that this will be a much greater crisis of credibility for the president and the ACA than the health plan issue has been.


About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.