Slowly but surely, the federal health exchange known as Obamacare has dropped Preferred Provider Organization plans off its menu. Like New York and others before it, citizens of the state of Texas will no longer be offered a PPO plan in favor of the cheaper option, a Health Maintenance Organization, for the next round of 2016 marketplace sign-ups.
This is yet another confirmation that President Obama stood before Americans and told a bold-faced lie: "If you like your doctor, you can keep your doctor."
PPOs allows the insured to see any doctor in their network without a referral from their primary care physician. This type of plan is generally more flexible, but it is also more expensive for insurance companies. In a PPO, a patient can see a doctor or a specialist and pay the same affordable co-pay upfront. However, the insurance company will have to reimburse the specialist more than they will a doctor. That's why the Affordable Care Act is ditching the plan for the more affordable HMO.
Under an HMO, a patient can only see a specialist through a referral from their primary care physician who makes the determination as to whether the patient actually needs to see a specialist. This type of gatekeeping and lack of choice in doctors brings down costs for insurance companies and is why the ACA is heading in this direction.
And for families in Texas, they are starting to feel the frustration caused by Obamacare's mandates.
The Houston Chronicle detailed a Houston-native who is being forced to sign up for an HMO through the ACA and risks losing the doctors she's used for decades:
Last summer, Brenda Hebert got a letter from her insurer, Blue Cross and Blue Shield of Texas, that it would no longer be offering her Preferred Provider Organization plan on the federal marketplace exchange for 2016.
Although irritated, Hebert reassured herself she would simply find a PPO plan with another insurer when enrollment opens on Sunday. That way, even if she changed carriers her doctors would still be covered.
But on Monday night, as she logged onto the Health and Human Services website to get a preview of the offerings, she discovered that not one company is offering a PPO plan in the Houston market on the legally mandated exchange.
"I don't know what I'm going to do," she said Tuesday morning as she contemplated the scramble to find new coverage in a Health Maintenance Organization Plan, a type of insurance plan she specifically does not want and fears will limit her choices of doctors. "I don't want to lose the doctors I have been going to for 20 years."
The Chronicle states that all PPOs are dropped and gone in Houston beginning in 2016 and the ACA will only offer HMOs. Last year, 19 PPOs were available across several providers.
Insurers are now sending letters out to its costumers stating that "the market has changed" since Obamacare became the law and are informing customers that PPOs are too costly to sustain and will need to be dropped going forward.
And its not only happening in Houston, but in Dallas as well, and soon to be followed by other cities and states.
Rice University's chair of Health Economics, Vivian Ho, spoke to the Chronicle about the deletion of PPOS. "I knew there would probably be some pullback, but I thought it would come in terms of premium increases, not pulling the entire product off the market," she said.
Law professor Seth Chandler of University of Houston's Health Law Policy Institute stated plainly, "It's dramatic that the fourth-largest city in the country does not have a PPO."
Ho added that having less choice in doctors is the "the price [we] have to pay" for taxpayers to foot the bill for each others' health care.
So that's what is left of the broken promises of this president -- looking for silver linings.