Implementation of the Affordable Care Act

Cross-Cutting Issues Six-State Case Study on Network Adequacy
A man in a suit fills out paperwork.

During the transition to new health plans and new marketplaces under the Affordable Care Act (ACA), many insurers revamped their approach to network design and now offer narrower provider networks for individual insurance plans than they have in the past.

 

The Issue: In this study for the Robert Wood Johnson Foundation’s project to monitor ACA implementation, researchers assessed network changes and efforts at regulatory oversight in six states: Colorado, Maryland, New York, Oregon, Rhode Island, and Virginia. Researchers found that insurers made significant changes to the provider networks of their individual market plans, both inside and outside the marketplaces, and that insurers took varying approaches.

Key Findings

  • Across all six states, insurers and state officials alike reported consumer and provider confusion about which plan networks included which providers, but most have received few consumer complaints about their ability to obtain in-network services.

Conclusion: While three of the six states have taken action to improve provider directories, it appears unlikely that state legislatures, officials and regulators will dramatically change network adequacy standards, at least in the short-term.

About the Study: Prepared by researchers at Georgetown University’s Health Policy Institute—Center on Health Insurance Reforms and funded by the Robert Wood Johnson Foundation, the report explores how insurance companies are keeping prices competitive while adhering to the standards set forth by the Affordable Care Act.