For weeks, Medicare Advantage insurer UnitedHealthcare has been a poster child for conservative grievances against the Affordable Care Act. The company, which covers 2.9 million of the 14 million elderly or disabled American enrolled in the private insurance program, announced it was dropping over 10,000 physicians from its network nationwide due to "substantial funding pressure from the federal government." But last Thursday, a federal judge said no to UnitedHealthcare's termination--without warning or cause-- of 2,200 doctors in Connecticut.
As Kaiser Health News reported, U.S. District Court Judge Stefan Underhill temporarily blocked the nation's leading Medicare Advantage insurers from cutting ties over 2,000 doctors in Connecticut. Ruling in favor of the motion brought by the Fairfield County Medical Association and the Hartford County Medical Association, Underhill concluded:
United's argument that it has a unilateral right to terminate participating physicians from participation in the Medicare Advantage plan by amendment of that plan is not supported by the language of the contract or the parties' experience under it.That decision came as welcome news to medical associations in other states, including Ohio and Florida, where UnitedHealthcare announced it was cutting out hundreds of doctors, and New York, where another 2,100 are on the chopping block. While the Ohio State Medical Association is reviewing Judge Underhill's decision, Dr. Sam L. Unterricht, president of the Medical Society of the State of New York responded:
"This is very good news from Connecticut. We will definitely seriously consider filing a suit in New York as well."As the Wall Street Journal reported in November, the New Yorkers could have a lot of company:
Several state attorneys general are investigating. Congressional delegations have complained about the company's timing and tactics to Medicare administrator Marilyn Tavenner, as did 43 national medical associations and 40 state medical societies in a joint letter on Nov. 6.Doctors, patients and their elected representatives have good reason to view UnitedHealthcare's claim that its sudden terminations are due mainly to government cuts to payments for Medicare Advantage services. After all, thus far none of the other major Medicare Advantage providers, including Humana, Aetna and Wellpoint, have gutted their physician networks as has UHC. Even more suspicious, UnitedHealthcare has unveiled its termination program after two years in which its parent company acquired its own physician practices in Florida, California and others states.
A spokeswoman for the Centers for Medicare and Medicaid Services said CMS is reviewing UnitedHealth's and other provider's networks "to ensure that beneficiaries have full, transparent and timely information and access to needed care."
As Kaiser documented in April 2012 ("Conflicts Arise As Health Insurers Diversify"), UnitedHealthcare has been at the forefront of insurance carriers buying out not just entire physician practices, but billing resolution firms doctors and hospitals use to make they get paid by insurers--like UnitedHealthcare. In 2012, UHC moved to strengthen its presence in Florida, where 10 percent of all Medicare beneficiaries live:
UnitedHealthcare, the giant nationwide insurer, is making a major move in South Florida by announcing Tuesday it has agreed to purchase two Miami-Dade based Medicare and Medicaid insurance plans that have more than 100,000 members and eight clinics.The acquisitions of Medica and Preferred Care Providers in Florida followed UnitedHealthcare's purchase of California-based Monarch Health Care in the fall of 2011. By February 2012, Blue Shield of California brought suit for $10.5 million in damages against the newly acquired 2,300 physician network which had been folded into UnitedHealth's Optum health services unit. As the Wall Street Journal reported:
Among the allegations: that Monarch sought to steer Blue Shield members away from Blue Shield and toward competing health plans, and that its doctors started declining to see some Blue Shield members. The complaint says these moves violated Blue Shield's contract with Monarch, which the insurer has previously said will end on May 1.According to the web site Modern Healthcare, Blue Shield also alleged that "Monarch physicians were refusing to make appointments with Blue Shield members and that Monarch is urging Blue Shield members to switch health plans via recorded phone calls."
"It seems crazy to be contracted with someone who's a direct competitor, and share everything you design with them," said Juan Davila, senior vice president for network management at Blue Shield, which has 3.3 million members. Blue Shield felt its "worry was proved true" by Monarch's alleged actions, he said.
Patients, doctors, hospitals other insurers and state regulators are right to be worried by insurers like UnitedHealthcare gobbling up physician practices, only to then limit policyholders to their own proprietary networks. As Bridget Maehr, senior financial analyst at A.M. Best Co. put it:
"It isn't so much about them getting into the business of care delivery as it is creating access for their members."Or, better yet, lack of access to any doctors but their own.
So, when health insurance companies complain that they must "narrow" their networks of doctors and hospitals in order to remain profitable under the Affordable Care Act, Americans should extremely skeptical. As for the right-wingers who charge that Obamacare is forcing Medicare Advantage insurers like UnitedHealthcare to drop thousands of doctors, scorn is the better response. After all, 95 percent of Republicans in Congress voted three years in a row for precisely the same Medicare cuts they decry now.