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Sloan-Kettering, Other Elite Hospitals Rejecting Obamacare Health Exchange Plans

One thing that is universal about the Affordable Care Act or Obamacare is that it was no one’s first choice. The entire bill was a compromise—how far that compromise went though is hotly contested—but its success was dependent on everyone playing their role. To call the rollout mismanaged is charitable, and now it seems that certain hospitals that offer premium care are going to exclude insurance providers from the health care exchanges, even if previously those insurers were accepted.

According to The Associated Press, Memorial Sloan-Kettering Center and “[o]ther premier city hospitals” are the latest hospitals to not accept the new plans. The hospitals claim their reticence to embrace these new plans is, essentially, that they are only accepting insurance plans where, according to a spokeswoman, there are “strong records in resolving and enrollment payment issues.” However many hospitals, including Sloan-Kettering, are still negotiating with insurers so this news may merely be a part of that negotiation.

In the early days of Obamacare—before the bill was even final—hospital associations were early allies of the law, the agreement facilitated by Vice President Joe Biden. However, despite cuts on the hospitals’ end to Medicare and Medicaid payments, once the bill passed both hospitals and the prescription drug companies were seen as the big “winners” in healthcare reform. Thus it remains unclear as to why hospitals are so publicly bailing out now.

However, with the rising trend in Ambulatory Surgical Centers and Urgent Care facilities and the ever-expanding amount of medical procedures they can perform the point may be moot. In an essay for Forbes, Dr. Robert Pearl speculates that the world of medicine may be evolving beyond large centralized hospitals with a vast staff of doctors, specialists, and services. It’s not a reduction of medical options per se, but is more decentralization. Of course, such a radical shift would bring about its own problems. 

UPDATE: Sloan-Kettering reached out to your correspondent via Twitter, taking exception to the idea that they were “opting out” of Obamacare. They have said that, “as of today” they are in the networks for two plans on the New York Small Business Exchange and in the networks for two plans on the Individual Marketplace. So while not technically “opting out” of the program, they seem to be severely limiting the center’s networks. Twitter exchange posted below:

@JoshuaMPatton We are not opting out. We expect to be in network with one or more plans.

— Sloan-Kettering (@sloan_kettering) November 22, 2013

@JoshuaMPatton As of today, we are in network w/4 plans on the NY exchange (2 on NY Small Biz Exchange and 2 on Individual Marketplace)

— Sloan-Kettering (@sloan_kettering) November 22, 2013


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