Just over 13 years after it was first enacted, the Affordable Care Act (ACA) seems to be experiencing major infrastructure issues. Unlike some systems issues of the same nature, this appears to be due to the overwhelming demand for ACA-based health insurance plans.
Within the last two years, there has been a surge in ACA enrollments. In addition, this was around the time that insurers began partnering with fewer health care facilities and providers in an effort to reduce costs during the pandemic.Â
Patients Struggling to Find Providers
Many new ACA members have been unable to find in-network services for both routine checkups and emergency care. This gap was partly worsened by the fact that many membersâ€™ new insurance companies were unable to help in the research process and could not offer updated lists of their provider network.
While this problem is finally coming to a head, it certainly isnâ€™t the first one the ACA has experienced, nor is this issue exclusive to companies that offer ACA plans.Â
Many insurers â€“ both those that offer ACA plans and those that do not â€“ have been offering more limited provider networks. Their reasoning may have been at least partly well-intentioned since a lot of insurers noted they did this to keep the cost of premiums down for their members. However, this move made it much more difficult for members to access the care they need, and it doesnâ€™t appear to be improving any time soon.Â
Provider Network Integrity
In an attempt to minimize the issues stemming from small provider networks, federal legislators are pushing for measures that confirm the networks insurers are offering their members. This legislation was delayed due to pushback from the Trump administration, but additional standards hope to accomplish a similar goal.Â
Federal lawmakers are putting time and distance standards into effect, which necessitates that provider networks have at least one representative from each health care specialty within a reasonable drive. Even in light of these policies, many members are still struggling with limited options along with lengthy wait times for new patients.Â
For this reason, regardless of whether or not they offer ACA plans, insurers should focus on expanding their provider network to offer a wider range of services and options to their members. This will not only improve the user experience for members, but it will also help them get connected with better care closer to home. By doing this, insurers and members alike will benefit from cost savings since greater health access is known to lead to better outcomes and decreased service utilization.
If you need help building or expanding your provider network to better serve your members, consult TOG Network Solutions.