Is the ACA Just Managed Care Redux?
NEW YORK ( MainStreet) While the Patient Protection and Affordable Care Act (ACA), commonly referred to as Obamacare, was touted as being an innovative reform of the delivery of medical services in America, many did not see much difference between it and managed care ideas proposed 25 or more years ago.
Now as the public and the politicians are learning about the actual policies and procedures of the ACA, people are reacting to it the same way they did to managed care - negatively. This, of course, is a function of the danger of not knowing what was in the bill until it was passed - as Nancy Pelosi, the Democrat Congressional leader from California so infamously said during the ACA debate.
One of the complaints about the ACA, now coming to the forefront, is that of limited access to physicians. Despite President Barack Obama's assurances that the ACA would not change people's ability to keep their insurance and their doctors, many are learning this is not true. Many insurers participating in the healthcare exchanges are limiting the cost of the plans by limiting the doctors and hospitals that will see their customers.
This was a practice that was established decades ago by Health Maintenance Organizations (HMOs) and modified later to what we now know as Preferred Provider Organizations (PPOs). It was a practice condemned by many of the same politicians who are singing its praises now.
Scott Harrington, professor of healthcare management and the director of the Risk and Insurance Program at Wharton, says the physician offerings have not maintained their breadth.
"Detailed data is not available, but there are reports that provider networks are narrow," said Harrington. "But now people will have some choices. If they want a limited network that is cheaper they can have it. We have got a portion of the population whose income is relatively low might so there be an attraction. It could quite well be a benefit for them. Yet there are some people who may have had plans that may be losing this and it creates the tension. But this is different from those who never had insurance."
Drexel Professor Robert I. Field, a nationally known expert in healthcare regulation and its role in implementing public policy, agrees. He is the author of a new book Mother of Invention: How the Government Created 'Free-Market' Health Care (Oxford University Press, 2013) that describes the government's role in guiding and shaping the American health care system.
"Obamacare is the latest iteration of a managed care approach to health reform," he said. "Many of its elements harken back to the Jackson Hole Group of the late 1980s and early 1990s and to the original concept of using HMOs to control costs and increase access."