[1]NNU - Medicare for All!

Happy New Year!

Now that 2025 is here, we’re continuing our email series to refresh you on
what Medicare for All is and how it would work by reviewing [ [link removed] ]the six
core MFA principles, which you can read and share with others here.

Today’s email is focused on the principle of freedom to choose your care
provider.

Right now, the freedom to choose your provider is a luxury very few people
have in the United States. Under our current for-profit health care
system, doctors, hospitals, and other providers are either “in-network” or
“out-of-network” with a person’s insurance company and specific plan,
limiting who they can seek care from.

According to the 2023 KFF Survey of Consumer Experiences with Health
Insurance, “one in five (20%) consumers with Marketplace plans reported
that in the past year, a provider they needed was not covered by their
insurance, and nearly one in four (23%) said a provider they needed to see
that was covered by their insurance did not have appointments
available.”^1

When a plan allows you to see an out-of-network provider, they rarely
cover the full cost: in many cases, insurance companies won’t pay a penny
for visits or services with out-of-network providers, or they will only
cover or reimburse a small fraction of the cost.

This can lead to horror stories like Gail Lawson’s, highlighted in an
April 2024 New York Times article about insurance companies cutting
out-of-network reimbursements as much as possible and dumping the costs on
patients. Gail needed an urgent procedure to treat a wound infection
following heart surgery. While she was able to get the care she needed, it
came at a shockingly steep price due to her narrow insurance network:

“...the doctor was not in her insurance plan’s network of providers,
leaving his bill open to negotiation by her insurer. Once back on her
feet, Ms. Lawson received a letter from the insurer, UnitedHealthcare,
advising that Dr. Rabinowitz would be paid $5,449.27 — a small fraction of
what he had billed the insurance company. That left Ms. Lawson with a bill
of more than $100,000.”^2

Because insurance plans change all the time — whether it be because
someone changed or lost their job, their employer switched their plans, or
the list of plans in the marketplace changed — people are at risk of
losing their preferred provider at any time. Just take a look at these
headlines from the past year alone:^3,4,5

[ [link removed] ]NBC 7 San Diego: Thousands of San Deigns scramble to find doctors amid
Anthem Blue Cross and Scripps Health fallout. Providers within the Scripps
Health system will, as of Jan. 1, be considered out-of-network for
patients covered by Anthem Blue Cross and Covered California.

[ [link removed] ]Stat+: UnitedHealthcare’s latest contract dispute, this time with
Trinity Health, leaves thousands out-of-network. Some members have not had
in-network access to Trinity’s hospitals or physicians since July 1

[ [link removed] ]KTXS 12abc: Resident worries about healthcare access after Humana
becomes out of network at Hendrick

To make matters worse, high insurance premiums are increasingly forcing
people into plans with narrow networks. For example, those with a choice
of plans through their employer often find that HMO plans, which are much
more likely to severely restrict your choice of doctors, have the lowest
premiums. Similarly, those who purchase plans through the ACA marketplaces
find that most feature narrow networks, limiting where you can seek care.

Under Medicare for All, networks would become a thing of the past: it will
ensure the ability to see ANY doctor you choose and will never force you
to stop seeing a doctor you like. Under this system, there would be no
networks, and since the government is the only payer, virtually every
provider will participate.

That means you will be able to see any doctor you want with no cost
considerations, no network limitations, and no risk you could lose your
doctor.

Passing Medicare for All into law would grant every person in this country
the true freedom to choose their own providers and the ability to keep
those providers without fear of disruption. Let’s keep building our
movement to make that a reality!

In solidarity,

Nurses’ Campaign to Win Medicare for All

 

1 - [ [link removed] ]How Narrow or Broad Are ACA Marketplace Physician Networks?
2 - [ [link removed] ]Insurers Reap Hidden Fees by Slashing Payments. You May Get the
Bill.
3 - [ [link removed] ]Thousands of San Diegans scramble to find doctors amid Anthem Blue
Cross and Scripps Health fallout
4 - [ [link removed] ]UnitedHealthcare’s latest contract dispute, this time with Trinity
Health, leaves thousands out-of-network
5 - [ [link removed] ]Resident worries about healthcare access after Humana becomes out
of network at Hendrick



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