I’d written a couple of time this past week on an upcoming legislative battle between the people who opposed Initiated Measure 17 this past election, and the impending battle did not go unnoticed by the state’s largest newspaper:
Businesses and consumers would have the ability to purchase health insurance plans that exclude some health providers under a bill that lawmakers will consider.
If passed, the bill would authorize so-called narrow network insurance plans, which have a small universe of health providers. The plans can be less expensive because the doctors and other health providers agree to charge lower amounts in exchange for the guaranteed volume generated by those covered in the plan.
But the bill could prove controversial because it amends an initiative that voters approved in 2014 requiring health insurance plans to be open to all providers who are willing to accept an insurance network’s terms and conditions. Initiated Measure 17 – which proponents dubbed as a “patient choice” measure – passed with a solid 62 percent majority.
It also opens another front in the long war between doctor-owned hospitals and the nonprofit hospital systems.
And with legislators back in Pierre today, a draft of the proposed legislation dated this past week found itself to me, titled “An Act to allow health care providers to offer plans that contain less than all of the health care providers on a panel of providers.”
And that title indicates the sort of problems that this legislation faces in the 2016 legislative session. As noted in the Attorney General’s explanation of the 2014 Ballot measure:
Some health insurers offer health benefit plans in which the insurer maintains a list of health care providers. Plan members must use listed providers in order to obtain the maximum plan coverage, or to have coverage at all. “Health care providers” include doctors and other licensed health care professionals, clinics and hospitals.
The initiated measure establishes who is entitled to be on the insurer’s list of providers. The measure requires that these insurers list all health care providers who are willing, qualified and meet the conditions for participation established by the insurer.
The law that was voted in by the 2014 election notes that everyone who is a “willing and qualified health care provider” be included “on their provider lists.” The bill (or at least this draft) expressly gives permission “to allow health care providers to offer plans that contain less than all of the health care providers on a panel of providers.”
Now, take it as you will, and interpret it as you will, but it’s difficult to see how the 2014 Ballot initiative supported by 62% of the electorate and this bill draft being circulated by it’s proponents can exist side by side without voiding the “any willing provider” provisions in state law as they apply to medical insurance.
This is a good post Pat. I think most of us never understood the ‘willing’ portion of this. It appears to refer to the providers willingness to accept the terms of and rates paid by the insurance company.
So the question becomes this… If a provider is willing to accept the rate of an insurance company, then why would an insurance company want to exclude them? Am I missing something here? I guess I just can’t figure out why choice and competition are a bad thing.
This bill seems unnecessary and certainly against the will of the people.
Plain and simple, this bill will abrogate the purpose of IM 17 and thereby run directly contrary to the will of the vast majority of South Dakota voters (62%). In 2014, I talked to a lot of voters about IM 17. Anyone supporting the measure would say, “I want to be able to see any doctor I choose and still get coverage under my health plan.” The voters were tired of the health systems directing patients to their own treaters/facilities through their proprietary health plans, all to keep the money in house. Sanford’s bill (above) will permit the return of those monopolistic (protectionist) types of plans, and the resurgence of the health systems using their health plans as tools to fence patients (and their money) inside the churner. Think about it – your premium payments go to Sanford’s Health Plan, your deductibles go to Sanford, your co-pays go to Sanford, the Sanford Health Plan turns around and pays Sanford, Sanford pays Sanford doctors….