Fwd: qotd: Seattle Children's Hospital excluded from most exchange plans

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-------- Original Message --------
Subject: qotd: Seattle Children's Hospital excluded from most exchange
plans
Date: Tue, 8 Oct 2013 12:34:22 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Seattle Children's Hospital
October 4, 2013
Majority of Washington's Health Benefit Exchange Insurance Plans Fail to
Cover Care at Seattle Children's; Hospital Sues Seeking Adequate Network
Coverage for Children and Families

Today, Seattle Children's Hospital filed suit citing the failure of
Washington state's Office of the Insurance Commissioner (OIC) to ensure
adequate network coverage in several Washington's Health Benefit
Exchange (Exchange) plans. We believe strongly that the OIC and the
majority of plans on the Exchange have failed to meet their mandate, as
they do not currently cover care provided at Children's.

Children's is the only pediatric hospital in King County and the
preeminent provider of many pediatric specialty services in the
Northwest. Some of these specialized services not available elsewhere in
our area or region include acute cancer care, level IV neonatal
intensive care and heart, liver and intestinal transplantation.

Without inclusion of Children's, current and future patients and
families who obtain insurance from several plans offered will not be
able to access care at Children's as an in-network provider. This lack
of suitable access to pediatric services means that families enrolled in
these plans may not receive the most timely, appropriate care, and face
larger out-of-pocket amounts.

"Every child should have access to essential healthcare and the intent
of the new Exchange is to make it available to all families," said
Thomas Hansen, MD, CEO, Seattle Children's. "However, we are very
concerned about the limited networks being offered by some Exchange
insurance plans. Omitting coverage for care at a facility like
Children's prevents families from accessing vital services they may
desperately need."

http://www.seattlechildrens.org/Press-Releases/2013/Majority-of-Washington's-Health-Benefit-Exchange-Insurance-Plans-Fail-to-Cover-Care-at-Seattle-Children's;-Hospital-Sues-Seeking-Adequate-Network-Coverage-for-Children-and-Families/


Comment: This press release from Seattle Children's Hospital presents
only one side of the story. Children enrolled in most of the plans to be
offered in Washington's insurance exchange will not have in-network
access to the crucial, highly specialized services only offered by
Seattle Children's Hospital. The financial exposure to those families
could be enormous. So what is the other side to this story?

There is tremendous pressure on the exchange plans to keep premiums
competitive. Although rates generally had been ratcheted down as low as
the market will tolerate, they could squeeze a little more out from some
providers by negotiating slightly lower rates in exchange for excluding
health care competitors. These limited networks are an insurer-driven,
cost-containment element of the new ACA exchanges.

Imagine a Seattle child with a major malignancy or with the need for an
organ transplant. Is it really reasonable that our "reformed" health
care system still exposes that family to severe financial hardship and
possibly bankruptcy? This is not what we should have expected from
comprehensive health care reform.

We need to go back and do it right - enact a single payer national
health program that removes financial barriers to all essential care for
everyone. Any child in Seattle that requires the specialized services
offered by Seattle Children's Hospital should have them. No exceptions.