New York physicians ask State Legislature to fix New York ACA implementation issues

MSSNY physicians urge lawmakers to take steps to assure the promise of good insurance coverage is met

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Westchester County plastic surgeon and MSSNY President-Elect Dr. Andrew Kleinman and New York City ophthalmologist Dr. Patricia McLaughlin today urged lawmakers to take steps to assure health insurance plans sold through New York's Exchange truly offer comprehensive physician networks. The physicians were participating in a hearing convened by the New York State Senate Health and Insurance Committees to hear about difficulties facing New Yorkers with the implementation of the Affordable Care Act in New York, including its impact on patient access to care.

"We remain committed to working with state policymakers, patient groups and other health care stakeholders to assure that New York's Exchange fulfills its promise to expand the availability of affordable and comprehensive health insurance coverage," Kleinman said. "But problems must be addressed immediately if we are to assure that patients have access to the care they expect to receive and deserve when they purchase coverage on the Exchange."

The problems highlighted in Kleinman's testimony include significant inaccuracies on insurer websites regarding which physicians are actually participating in these Exchange networks; vague communications with physician offices that fail to clearly specify that physicians are being directed to participate in Exchange products unless they opt out; failure to specify payments for care delivered to patients enrolled in Exchange products; and, for many, discovering the payments for such care are grossly inadequate compared to other products offered by that insurer with whom the physician was participating.

McLaughlin highlighted multiple issues she has faced with regard to the implementation of the ACA in New York. She faced a "double-whammy" of having the coverage she provided to her employees being terminated by Empire, and replaced with a less generous plan with higher out-of-pocket costs and more limited network, as well as being dropped as a participating physician for the replacement plan. Her story was recently featured in the New York Post.

"No patient should have to give up all the doctors that they trust and have had long-standing doctor-patient relationships over many years," McLaughlin said in her testimony.

McLaughlin and Kleinman both said exacerbating the problem of more limited networks is the fact many health plans have substantially reduced or completely eliminated previous coverage options that permitted patients to see the physician of their choice. As reported in multiple recent press accounts, no insurer in downstate New York is offering a policy in the individual Exchange with out-of-network options, and only one insurer is offering policies with out-of-network coverage in the small business Exchange. To address this problem, Senator Hannon has introduced legislation (S.6207) to require health insurers to offer out-of-network coverage both inside and outside the Exchange.

"By far, my greatest concern is the impact upon the doctor-patient relationship as a result of the confluence between these limited networks and the greater numbers of insured lives," McLaughlin said. "Patients with acute conditions and their primary physicians will lose precious time attempting to locate a qualified specialist and hospital to treat the condition in a timely fashion."

Founded in 1807, the Medical Society of the State of New York is the state's principal nonprofit professional organization for physicians, residents and medical students of all specialties. Its mission is to represent the interests of patients and physicians to assure quality health care services for all.