If You Like Your Doctor, Too Bad

You can't keep that either.

In 2013, the American people learned what whoppers the key promises of ObamaCare turned out to be. But the biggest whopper about the Affordable Care Act is yet to be exposed: the tightening grip the federal government will have over your doctor — even if you’re paying with private insurance.

Like so many other parts of ObamaCare, the reality flies in the face of promises. In this case, it was the one where the president assured us that “you’re not going to have anybody getting in between you and your doctor in your decision making.”

Section 1311(h)(1)(B) of the health law gives the secretary of Health and Human Services blanket authority to dictate how doctors treat patients. Not just patients in government programs like Medicare and Medicaid, but patients with private plans they pay for themselves. On Dec. 2, 2013, we learned from the Federal Register that the rules are now being written. Starting in 2015, insurance companies will be barred from doing business with doctors who fail to comply. The rules will be offered in the name of ensuring “health-care quality,” which of course could mean anything.

“The powers given to the secretary are so broad, he or she could literally dictate how all physicians nationwide practice medicine,” warns Congressman Phil Gingrey (R. Georgia), himself a physician. Gingrey is sponsoring a bill to repeal Section 1311(h)(1)(B). Otherwise, he says, the HHS secretary — a Washington bureaucrat with no medical training — could, for example, bar doctors from doing routine mammogram screenings until female patients turn 50. In short, the federal government will be calling the shots on what patients get.

More on this topic here.

More important, the analysis of costs alone misses the central point. While Blue Shield is not charging a great deal more than PacifiCare would have under their old plan, it is for a vastly inferior product. As Mrs. Sundby wrote in her op-ed, she has received care from three hospitals. Her primary oncologist is at Stanford University's Cancer Institute. She got less specialized treatment such as chemotherapy locally, at Moores Cancer Center, part of the University of California, San Diego. She has also been treated at the M.D. Anderson Cancer Center in Houston.

No plan available in San Diego includes both UCSD and Stanford in its network, so the Sundbys were forced to choose between them. The Blue Shield plan covers care at Stanford, so that she will now have to get local care elsewhere. 

Volsky did acknowledge in his penultimate paragraph that Mrs. Sundby "may need to find a different health care provider. . . . If Sundby continues to see the non-participating doctors, she will incur additional out-of-pocket health care costs." That is, he treated as an afterthought the actual injury ObamaCare inflicts on her. She was victimized twice by the president's consumer fraud. She lost the plan she liked and doctors she liked.

We didn't write about this in November because our conversation with the Sundbys' broker left us confused. The broker believed that ObamaCare plans would cover out-of-network treatments, with higher copayments but the same limit on total out-of-pocket expenses. That called into question the premise of Mrs. Sundby's op-ed: Had the broker been right, Mrs. Sundby would have been able to get the same care at only somewhat higher cost.

But the broker was misinformed. Mrs. Sundby confirmed with an administrator at UCSD that none of the plans that included Stanford in their networks would cover the full cost of treatment at Moores. Mrs. Sundby told us that her new plan covers out-of-network care only up to the (far lower) negotiated fees for equivalent treatment within the network; the difference must be paid out of pocket and does not count toward the annual limit on out-of-pocket expenses.

That makes the cost of care at UCSD prohibitive and forces Mrs. Sundby to go to a lower-quality facility. (The Moores website boasts that it "is one of just 41 National Cancer Institute-designated Comprehensive Cancer Centers in the United States, and the only one in the San Diego region.") Mrs. Sundby told this columnist she is uncertain whether she will be able to return to M.D. Anderson should she need care there.