Editorial: Don’t give Oregonians more healthcare whiplash

Published 12:00 am Sunday, July 20, 2014

All of the health care changes have been enough to give Oregonians whiplash. And in Oregon there’s another change coming.

This one could be very good for consumers — as long as it’s done right. But of course, Cover Oregon could have been very good for consumers, if it had been done right.

The new problem targeted by the Oregon Insurance Division is this: Consumers can have a hard time figuring out just how good a health insurance network is when they are selecting health insurance.

How are consumers supposed to tell if there are enough providers in a network to serve patient needs? Even if a health insurer has a list available of all the doctors in its network, it’s often unclear if those doctors are accepting new patients.

The Oregon Insurance Division — in consultation with providers and insurers — is tackling this issue of network adequacy and trying to come up with legislation to propose for the 2015 session.

The legislation is not finalized. But the draft language suggests Oregon may adopt rules for network adequacy that already exist, such as those for Medicare.

That’s a good approach. Oregon is still reeling from trying to invent its own health care website. Let’s keep things simple for network adequacy. If insurers, providers or consumers believe they need more flexibility than the national standard Oregon adopts, then there can be discussion about Oregon coming up with its own standards in addition to a national standard.

The state should also be careful about overly strict requirements. Smaller health care networks can hold down costs for consumers. Large group insurance policies sometimes consciously choose smaller provider networks for that reason. Oregon’s rules should be careful not to interfere, more than is absolutely necessary.

More transparency for consumers in picking a health plan should be a good thing. The state’s goal should be to achieve that with zero whiplash for consumers, providers and insurers.

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