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Are Quality and Choice being sacrificed
in the health care exchanges?
October 21, 2013

Are Quality and Choice being sacrificed in the health care exchanges?

By James R. Davis, CEO & President, University Health Care System

By now, everyone’s heard of the health insurance exchanges, created as part of President Obama’s Affordable Care Act. In theory, they’re supposed to make health insurance available for people who previously could not afford insurance, who were not insured because of pre-existing conditions or were not offered workplace coverage. To say there is a lot of confusion surrounding these exchanges and their implementation is an understatement. There have been reported delays in accessing the exchanges on the federal websites, and no one within the federal government can give an accurate count of how many people have signed up for insurance through the exchanges.

In Augusta, two insurance companies have entered the exchange market, Blue Cross Blue Shield (BCBS) and Humana.

First of all, to avoid any further confusion, it’s important that we emphasize that University Hospital is a Blue Cross Blue Shield provider for all of their commercial products including products being offered to active members of the State Health Benefit Plan. However, University was informed last Friday that we were not included on the public exchange product offered by Blue Cross Blue Shield. University was the only Augusta hospital excluded despite being recognized as the 6th ranked hospital in the state for quality by US News & World Report. And University is not alone – 8 of the top 10 ranked hospitals in Georgia were excluded from the BCBS network. What this means is a narrowing of consumer choices all over the state, including Augusta. In addition to our US News & World Report top 10 quality ranking, University has been named the National Research Corporation Consumers’ Choice Award winner for overall quality for 15 years in a row. We also hold the Blue Cross Blue Shield Distinction Center+ recognition in hip replacement, knee replacement and spine surgery, signifying we have displayed great expertise and efficiency in these areas. These are just a few of many quality distinctions we hold throughout the region. There is no question that University is a quality leader when it comes to taking care of our patients. We believe new enrollees on the exchange should have access to the same level of care our community has become accustomed to receiving from University.

There were no negotiations with BCBS or discussions with us regarding rates. When we called to ask if we could be included in the network, we were told that the exchange had been set for the next year. This represents a total departure from the relationship we have had with BCBS in the past. If this is a glimpse of the future under the new Affordable Care Act, we should all plan on narrower choices of providers with little regard for quality.

The good news, if there is any here for those who would prefer University, it is that Humana’s public exchange does include University Hospital in its network, and according to www.healthcare.gov their family premium is priced significantly less expensive ($595.16 for Humana versus $718.64 for BCBS coverage—a 20.7 percent difference).

The immediate impact of the creation of these exchanges has been a narrowing of choices for consumers. For patients in our community currently enrolled in BCBS commercial products, University remains a network provider. For those who are making choices on the new public exchange, the BCBS option has narrowed your choices and excluded the community’s top quality provider.

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1350 Walton Way, Augusta, Georgia
(706) 722-9011