ObamaCare Might Make Health Care Less Competitive

See Out of Network, Out of Luck by THERESA BROWN, NY Times, 10-13-13. She is is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.” Excerpt:

"Historically, insurance companies have had more market power than hospital systems: they set reimbursement levels, determined which providers and hospitals were in or out of network and chose which patients to insure.

The Affordable Care Act, however, is changing that. By mandating that insurance companies can no longer deny coverage because of pre-existing medical conditions, or set lifetime caps on total payouts, the act curbs what some would call past insurance company abuses, and in the process cuts back some of the industry’s market power.

But while health insurance practices are becoming more regulated, the act, by offering incentives for coordinated care, has encouraged hospital mergers and the buying up of physician practices.

In line with those changes, more health systems nationally are following the lead of U.P.M.C. and Highmark, combining health insurance with the provision of care itself. The systems promise that such networks streamline care and offer lower costs and consistently good outcomes for patients.

But the worry is that integration will yield not better care but higher profits achieved through monopolistic consolidations and self-serving business practices. The cost of care for an entire geographic region could increase without making patients better off.

Further, if rural hospitals become part of large integrated systems, patients could be shut out from the only nearby hospital, as was feared recently in Altoona, Pa., when U.P.M.C. acquired Altoona Regional Health System."