Cal­i­for­nia bill on nar­row net­works un­der­mines the con­cept

Modern Healthcare - - COMMENT -

Re­gard­ing “Nar­row-net­work con­tro­versy spurs tougher rules for Cal­i­for­nia plans” (Mod­ern­Health­, Sept. 2), as with most is­sues re­lated to health­care re­form and how to best serve pa­tients, it’s com­pli­cated. In this case, the prob­lem is very real—how to im­prove ac­cess to care with­out in­creas­ing costs.

This bill at­tempts to solve the “nar­row-net­work prob­lem” by al­low­ing pa­tients to get care out­side of the net­work, which un­der­mines the very mech­a­nism de­signed to keep rates lower. If passed, the law could re­verse the fa­vor­able med­i­cal-cost trend Cal­i­for­nia is fi­nally en­joy­ing and cause rates to in­crease as more care is ac­cessed by higher-cost, lower-qual­ity providers. Like Propo­si­tion 45 (a ratereg­u­la­tion ini­tia­tive), it ap­pears to solve one prob­lem by cre­at­ing a new and larger one.

Th­ese ini­tia­tives are sup­ported by sin­gle-payer ad­vo­cates who pre­fer to dis­man­tle the pri­vate health in­surance sys­tem in fa­vor of a Medi­care­for-all model. While I don’t fa­vor a sin­gle-payer sys­tem, if that is what the bill spon­sors want, then let Cal­i­for­ni­ans vote on it in­stead of pack­ag­ing a bun­dle of bills and call­ing it some­thing else. If the gov­er­nor wants to pro­tect af­ford­able health in­surance, he will not sign the bill and, hope­fully, will lis­ten to the ex­perts who are al­ready im­ple­ment­ing so­lu­tions for en­sur­ing net­work ad­e­quacy.

Michael Lu­jan Pres­i­dent-elect Cal­i­for­nia As­so­ci­a­tion of Health­care Un­der­writ­ers Red­wood City

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