Obama Care Exchanges - County by County - Not State by State
California created it's own Obamacare Exchange, but the California Exchange shares one feature with the states who allowed the Federal Government to create their state exchanges, the insurance market place created by the exchanges are not state-wide.
Insurance Companies can offer an insurance policy that is available in only one county within a state. The medical insurance markets within Obamacare exchanges are county markets, not state wide markets.
This is seldom discussed in the Media, but it is having a huge impact on how insurance companies manage risk and manage costs.
New York Times newspaper wrote:
Of the roughly 2,500 counties served by the federal exchanges, more than half, or 58 percent, have plans offered by just one or two insurance carriers, according to an analysis by The Times of county-level data provided by the Department of Health and Human Services. In about 530 counties, only a single insurer is participating.
The access to emergency care regulations, included in the Obamacare law in return for political support for the Obamacare by hospital associations, strongly encourages insurance companies to issue insurance policies for the smallest geographic areas possible. This was not the intent of the Obamacare law, but the unintended consequence of the Insurance Companies attempting to avoid cost increases resulting from the change to the law in favor of hospitals. By insuring the patients homes are close to In-Network emergency care facilities near ( near as defined by the Obamacare law ) where the patients live, can avoid paying very large "emergency charges" that otherwise might occur. The same large insurance company can issue scores of insurance policies within a state, but each policy is open only to patients who live in a single county, and uses only In-Network hospitals and In-Network doctors within that county, thus avoiding the risk of much higher, non-contracted emergency health care costs, a state-wide policy would have made the insurance company ( not the patient ), liable for under the Obamacare law.
The county by county healthcare markets also increase costs for patients, and decrease competition between insurance companies for patients
Denied the ability to manage risk based on the health status of the patient, insurers are compensating by drastically raising deductibles, co-pays and sometimes premiums in counties where the patients have so few choices they will have to pay.
The impact on Hospitals and Doctors within those counties is also substantial, it gives the gigantic nation-wide insurance companies, which issue large business, small business and individual health insurance policies alike, the opportunity to pick winners and losers among the local county hospitals and the local county doctors ( based primarily on the interest of the insurance company, with the interest of the patient and the interest of the local community being of secondary and tertiary importance to the insurance company ). A county hospital that is excluded from the In-Network hospitals in all the insurance policies issued for patients within that county might be facing bankruptcy.
The Media has not been covering this, even in the individual market, except in relation to the most superficial measures of Obamacare such as number of insurance policies offered in a county, and monthly insurance premium prices. Deductibles and In-Network provider issues are not being addressed by the Media on a county by county basis. Even premiums are rarely being addressed on a county by county basis.
The political debate before Obamacare passed was if the policies should have been state by state, or all 50 states.
The Obamacare federal law details finalized in back rooms by Democratic staffs with the help of ( employees of and representatives of ) the insurance industry, implemented County by County health care marketplaces, NOT State-wide marketplaces and NOT United States wide insurance markets.
Good or Bad, for various players in the Health Care Industry, this has NOT been widely covered by the media in even a superficial manner, and rarely, if at all, in an in depth manner.
Here are a few news media articles that cover it in passing:
http://thelead.blogs.cnn.com/2013/11/04 ... er-prices/
http://www.nytimes.com/2013/10/24/busin ... areas.html
http://online.wsj.com/news/articles/SB1 ... 0423780446