As we attempt to stave off the on-again, off-again House Republican repeal efforts, the Trump administration is also taking a quieter “wait for failure” approach that sets the stage for administrative and regulatory actions that could weaken the foundation of the law. One of these foundational provisions is the assurance that marketplace consumers have sufficient access to providers and care – or network adequacy. Therefore, it is more important than ever for states to step up to the plate to protect coverage and access to care for the millions of consumers who rely on marketplace plans.
Network Adequacy Advocacy Matters More than Ever in the Trump Era
Over the past few years, insurers have trended towards narrow network plans – especially those in the marketplace – in order to reduce premium costs for consumers. Although narrow networks are not inherently bad, consumers have little information on the tradeoff between lower premiums and network size, and are put at greater risk for surprise balance billing. Evidence has shown profound impacts of narrow networks on consumers, including inadequate coverage for some chronic health conditions, disruption in care and confusion over provider directories that can result in burdensome balance billing from out-of-network providers.
To a certain extent, consumers on the marketplace are protected by the ACA’s minimum network adequacy standards. However, in its first health care regulatory action, the Trump administration proposes to take a hands-off approach to enforcing network adequacy matters, punting responsibility to the states.
State Activity Around Network Adequacy Is Alive and Well
Fortunately, state activity around network adequacy is still active. During the current legislative session, initiatives to address surprise billing sprang up in several states – including Georgia, New Jersey, Texas, Oregon and Washington. Massachusetts is also working on improving provider directories. Success stories from the last couple years can guide continued advocacy efforts to strengthen state network adequacy protections where federal regulation and enforcement fall short. For instance, advocates played a pivotal role in helping pass laws in Georgia and Maryland that ensure updated and accurate provider directories, and helped put an end to surprise medical billing in California, Florida and New York.
We developed a case study highlighting how leadership from consumer advocacy groups like Georgians for a Healthy Future lead to a legislative win for one of the strongest provider directory laws in the country. One of the key advocacy strategies advocates in Georgia employed was strong engagement with state officials, policymakers and industry stakeholders. This strategy and more can be found in the case study as well as the strategic campaign template we developed specifically for network adequacy advocacy.
As the future of the ACA remains uncertain, insurers are likely to push for more narrow networks in order to deliver competitive low premiums for consumers. Moving forward, it is important that consumer health advocates work closely with policymakers and government officials in their states to shape policies that protect access to affordable and comprehensive coverage.