by Scott Gottlieb
American Enterprise Institute
June 18, 2014
Americans who sign up for insurance under the Affordable Care Act are finding that many of these plans offer very narrow options when it comes to their choice of doctors and drugs. The rules embedded in the ACA made restrictive drug formularies and narrow provider networks almost inevitable by mandating costly new benefits, by barring insurers from pricing coverage to risk or make full use of co-pays as a way to manage utilization, and by tightly controlling premium increases. The ACA instigated a forced migration of consumers into HMO-style plans. Reforming access to drugs and doctors will require Congress to give health care consumers a wider set of options. Congress could allow a wider choice in the state-based exchange. The restrictive networks and formularies are an unfortunate consequence of the structure of the ACA – but Congress has the power to fix that.



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