White House orders broader Obamacare health plans in 2015


(Photo by Mark Wilson/Getty Images)

The Obama administration is requiring health plans in Obamacare insurance marketplaces to include a more robust offering of care providers in 2015 after some early backlash over limited networks in the health care law's first year.

Health plans selling on the federal marketplaces in 2015 must include 30 percent of area "essential community providers," which are usually health centers and other hospitals serving mostly low-income patients. That's up from a 20 percent requirement in 2014, the first year of expanded overage under the health care law.

The federal Centers for Medicare and Medicaid Services, which oversees the marketplaces, will also take a much more active role in reviewing health plan networks. CMS, which outlined the new standards in a Friday night letter to insurers, will evaluate whether the plans include enough access to hospitals, primary care doctors, mental health providers and oncologists.

The updated standards came after a Friday interview in which President Barack Obama acknowledged that pressure to keep down costs could mean consumers may not have access to their choice of doctor.

“You may find out that network is more expensive than another network, then you have to make choices in terms of what’s right for your family,” Obama told WebMD. “Do you want to save on costs, or do you want to save on convenience?”

A senior administration official defended the health law’s standards in a Friday afternoon statement.

“What is what true before the health law is true today insurers have always made decisions about which providers and doctors are in their networks – that won’t change,” the official said. “What is different now is the Affordable Care Act marks the first time that federal law requires insurance plans to offer adequate networks of doctors, including mental health practitioners, pharmacies, hospitals, and community providers. Americans can now choose between different types of plans with different networks to find a plan that best meets their needs.”

CMS late Friday night also released a slew of new standards related to the insurance marketplaces, also known as exchanges. For instance, the agency issued new rules related to in-person Obamacare assisters, known as navigators. It also builds on small business insurance marketplaces, which have face several delays in the law's rollout.

CMS also said it will excuse insurers' administrative spending for costs stemming from the failed roll out of Healthcare.gov. The health law requires insurers to provide rebates to customers if they spend more than 20 percent of premium dollars on administrative costs, but CMS says it won't count administrative costs related to the enrollment website's turbulent launch.

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
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Jason Millman · March 14