Studies shed new light on Affordable Care Act exchange plans' provider networks

Male doctor in white lab coat
A new study has found that 60% of provider networks in plans offered in the federally facilitated marketplaces in 2016 included at least a quarter of local physicians. (Getty/Saklakova)

As Congress prepares to debate how to fix problems like rising premiums and insurer exits from the Affordable Care Act exchanges, two new studies dive into an issue that isn’t brought up as often on Capitol Hill: health plan network adequacy. 

Both studies, published in the September issue of Health Affairs, note that there is considerable concern about how the increased use of narrow-network insurance plans on the exchanges impacts consumers’ access to care.

But in a finding that might quell some of those misgivings, one of the studies determined that 60% of provider networks in plans offered in the federally facilitated marketplaces in 2016 included at least a quarter of local physicians. 

RELATED: 3 lessons on regulating health plan network adequacy

In terms of network stability, researchers found that consumers’ access to broad-network plans remained stable between 2015 and 2016. And consistent with past research, the study noted that large-network silver plans had 6% to 7% higher premiums than extra-small network silver plans, suggesting an upside to smaller networks among price-conscious exchange shoppers.

Yet the same study also found that Hispanic and low-income people made up a disproportionate share of enrollees in smaller-network plans—ones that included fewer than 25% of local physicians. Given that disparity, the researchers note, “it will be important to monitor plan offerings, enrollment and outcomes, especially among vulnerable populations, to ensure that narrower networks are not associated with decreased access to high-quality care.”

The other study, meanwhile, looked at ACA exchange plans’ provider networks in a different way, comparing their inclusion of mental health providers to the inclusion of primary care providers.

Looking at data from 2016 marketplace plans, it found that provider networks for mental health care were “far narrower” than those for primary care. For example, while 38.7% of plans had extra-small or small networks for primary care physicians, 57.4% of plans had extra-small or small networks for psychiatrists.

One of the factors driving that finding, the study says, is that there were lower rates of network participation among mental health care providers compared to primary care providers. On average, exchange plan networks included 24.3% of all primary care providers, compared to just 11.3% of all mental health care providers practicing in a given state-level market. 

Such low network participation among mental health care providers, the researchers argue, “may undermine the ability of both federal parity laws and the ACA to guarantee access to mental health care.” 

Suggested Articles

A major physician group is urging the Centers for Medicare & Medicaid Services to continue allowing for audio-only patient visits under COVID-19.

At its investor conference on Tuesday, UnitedHealth Group offered an update on its 2020 guidance and provided the first look at its outlook in 2021.

Walmart has tapped Cambia Health Solutions' Cheryl Pegus, M.D., to serve as its new executive vice president of health and wellness.