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New State Rules Could Limit Cheaper Health Plans With 'Narrow Networks'

Ted S. Warren
Associated Press
Insurance Commissioner Mike Kreidelr (File image)

The practice of offering relatively inexpensive health plans with bare-bones provider networks has created tension between making health care affordable and keeping it accessible. It’s set to come to a head this week in Olympia.

The growth of “narrow networks” in Washington comes as the Affordable Care Act limits the ability of insurance companies to control their costs. That’s made it harder to offer plans at a range of prices — something the companies want to do as they compete for comparison shoppers on the health exchanges.

Many companies figured out they could sell cheaper plans that offer consumers fewer choices of where to get care. That caught some consumers, and Washington’s insurance commissioner, by surprise.

Commissioner Mike Kreidler says companies need to justify those narrow networks.

“We want to make sure that if you’ve made the promise that you can get this care, that there’s going to be a delivery on these services,” Kreidler told the Health Benefits Exchange Board at a recent meeting.

Kreidler is expected to approve new rules this weekthat would make it harder for insurers to thin out their networks. He says consumers should have some basic safeguards: You shouldn’t have to drive too far or wait too long for care, and you should be able to find the specialists you need.

Kind Of ‘Big Brother’

But Kreidler quickly found himself under a minor siege from board members like Bill Hinkle.  

“This is called the Affordable Care Act, not the Accessible Care Act,” said Hinkle, a former state lawmaker.

Board member Bill Baldwin lobbed a string of adjectives at Kreidler’s proposal: “burdensome,” “bureaucratic,” “complicated,” “excessive,” “countercompetitive,” “counterproductive” and “kind of Big Brother.”

Sydney Smith Zvara of the Association of Washington Healthcare Plans says the new rules would require stacks of paperwork, including thousands of maps.

“The sheer weight and volume of the administrative and reporting requirements that come along with that have the effect of just smothering the ability to provide more innovative networks," Zvara said.

Protecting The Consumer

Kreidler says he doesn’t believe prices will increase. He sees himself as walking a fine line, but with his compass oriented decidedly toward the consumer.

“My charge here and my responsibility is to protect the consumer,” Kreidler told the Exchange Board, jabbing the table with his finger. “If you sign up for a policy, you have a right to expect that you’re going to have access to a provider.”

All the interested parties will get one more crack at Kreidler before he finalizes the rule. There’s a public hearing Tuesday morning, though the commissioner's office concedes that little is likely to change before he signs off on the rules a day or two later.

Gabriel Spitzer is a former KNKX reporter, producer and host who covered science and health and worked on the show Sound Effect.