- Americans who sign up for insurance under the ACA are finding many of these plans offer very narrow options.
- While narrow networks aren’t unique to the ACA, these constructs are far more prevalent in the ACA.
- The restrictive networks & formularies are an unfortunate consequence of how the ACA structured the exchanges. It is within Congress’ power to fix these rules.
Americans who sign up for insurance under the Affordable Care Act are finding many of these plans offer very narrow options when it comes to their choice of doctors and drugs. Some observers argue the insurance business tactics resulting in these narrow benefits are not unique to the ACA plans. But this isn’t entirely true.
The rules embedded in the ACA made these very restrictive drug formularies and narrow provider networks almost inevitable, and certainly far more prevalent. It popularized these approaches, and made them politically acceptable. I want to briefly highlight some of the reasons why I believe these outcomes were made inescapable by the way that the rules were crafted under the ACA. I want to briefly describe how these restrictive drug plans and provider networks are taking shape and affecting patients. Finally, I want to make some recommendations on how we can reform the ACA and unwind some of these challenges.