ACA's Narrow Networks Leave Big Gaps In Health Care Coverage

MICHEL MARTIN, HOST:

And we're going to continue our conversation now with Words You'll Hear. That's where we pick a word or phrase that will be in the news this week and learn the background behind it. This week, we're picking two words, and they have everything to do with the situation that Christopher Briggs and his family is in. And the phrase is narrow networks. To understand the phrase, we're joined now by Julie Rovner, Washington correspondent for Kaiser Health News. Welcome back, Julie.

JULIE ROVNER, BYLINE: Nice to be here.

MARTIN: So what does narrow networks mean, and how does it relate to the Briggs family?

ROVNER: Well, this is something that dates back to the beginning of the Affordable Care Act. Remember, they're required - insurers are required now to provide this wide array of benefits. And when they were starting to put together their plans, they thought, how are we going to do this and still keep this insurance affordable? And one of the ways they did that was by having what we call narrow networks, meaning they only contract with a limited number of doctors and hospitals. And the hospitals that they most often don't contract with are these big teaching hospitals because they tend to be expensive.

So we've seen this not just in places like Virginia, but we've seen it across the country starting in 2014 when this began, where people who had children or family members or themselves in the middle of - often, cancer treatment - were suddenly cut off from their hospitals. So it is a big problem for people who have ongoing care needs like this family. This year, when there are so many insurers that have pulled out of the market - because as you discussed, of the instability and the things that the president has done - there are more people who only have a choice of one insurer. So that if that insured doesn't cover the hospital that they need, they have a problem like the Briggs.

MARTIN: But is this an ACA problem? Is this a problem that exists primarily because of the Affordable Care Act and all the sort of political wrangling around it?

ROVNER: It is more intense within the Affordable Care Act plans because, as I mentioned, they have to cover all of these various benefits, and they need to keep the prices down because they're competing, in some cases, with other plans. But also, people are paying the full freight. But you do see this also in employer plans, you know, particularly for smaller employers, who have to pay more - for whom it's a bigger burden. You see narrower networks there, too, where they don't contract with very many providers.

But we've seen this kind of - we saw this kind of fight here in Washington, D.C., some years ago when the federal Blue Cross plan had a fight with Children's Hospital. And the winner of that fight was the Washington Post because there were full-page ads every day for weeks before they could come to some kind of agreement.

MARTIN: So when it comes to looking for insurance on the exchanges, I take it that it's important to shop around. But can people still shop around?

ROVNER: Well, it is to the extent you can. It looks like about a quarter of people on the exchanges will only have a choice of one insurer. Now, they can shop around within that insurer for different plans, and that is still important. When it comes to these networks, they're largely the same. So if you have a problem with the network, you have to do what this family is doing and try to sort it out with the insurer or with the hospital - you know, with the facility that you need. But yes, it remains really important to shop, particularly if there's some provider that you know you need.

MARTIN: So we only have about a minute left, Julie. So the bottom line is the Briggs family are not the only people in this situation. It's a particularly heart-wrenching situation, but they're not the only people in that situation.

ROVNER: No, not at all. But the fact that so many insurers left the market this year and there are so many people who only have a choice of one insurer, the problem has been exacerbated.

MARTIN: And finally, how is enrollment looking? There's just a couple of weeks until the deadline. You know, what do we know?

ROVNER: Well, enrollment is looking pretty brisk. But because the enrollment period is only half as long, it would have to look twice as brisk as it did last year to get to the same number. It's not clear it's that much, but we'll know more in the coming weeks because people sign up at the very end.

MARTIN: That's Kaiser Health News Washington correspondent Julie Rovner. Julie, thanks so much for joining us once again.

ROVNER: My pleasure.

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