Witness: “Coverage doesn’t necessarily equal access.”
WASHINGTON, DC – The House Energy and Commerce Subcommittee on Health, chaired by Rep. Joe Pitts (R-PA), today held a hearing to examine how, “The President’s Health Care Law Does Not Equal Health Care Access.” Pitts noted that the president’s repeated promise of “If you like your doctor, you will be able to keep your doctor, period,” remains on WhiteHouse.gov, despite the fact that it is widely agreed that the president would never be able to uphold this promise under this law.
As Scott Gottlieb, M.D., Resident Fellow at the American Enterprise Institute explained, “Coverage doesn’t necessarily equal access. … Just giving someone health care coverage doesn’t necessarily guarantee that they are going to get care.”
Gottlieb added, “Americans who sign up for insurance under the Affordable Care Act are finding many of these plans offer very narrow options when it comes to their choice of doctors and drugs. Some observers argue the insurance business tactics resulting in these narrow benefits are not unique to the ACA plans. But this isn’t entirely true. The rules embedded in the ACA made these very restrictive drug formularies and narrow provider networks almost inevitable, and certainly far more prevalent. It popularized these approaches, and made them politically acceptable.”
Full committee Chairman Fred Upton (R-MI) explained, “Analyses have shown that, in order to comply with the law’s many taxes and mandates, provider networks have necessarily been limited. But, it is the sickest Americans who are being hurt the most. Patients with cancer, HIV/AIDS, multiple sclerosis, and autoimmune diseases who are purchasing silver plans through the health care exchanges are facing coinsurance rates often as high as 40 percent of the cost of their drug. On average, patients are paying 130 percent more in out-of-pocket costs for medicines in silver plans on the health care exchanges when compared to employer-sponsored coverage.”
Pitts commented, “A constituent from Conestoga, PA, wrote to me that after her policy of nearly 30 years was cancelled last fall because it was not fully ACA-compliant, she was unable to find a new exchange plan which included her doctors in its network. Her OB-GYN, whom she had been seeing since 1989, and her gastroenterologist are now out-of-network.”
Vice Chairman of the Health and Oversight and Investigations Subcommittees Michael C. Burgess, M.D. (R-TX) added, “Plans sold on health insurance exchanges are leaving people functionally uninsured. … Many of the nation’s leading cancer centers and pediatric hospitals are not included in the provider networks of exchange plans. And access to necessary specialty drugs often comes at a tremendous cost.”