Editorial: Insurance company cuts could shortchange state seniors

Wednesday, November 20, 2013

According to the Providence Journal, 36,000 R.I. seniors enrolled in United HealthCare’s Medicare Advantage Plan will have fewer treatment options as of Feb. 1. The insurer notified almost all surgeons at Rhode Island Hospital, roughly 70 percent of the surgeons at Miriam Hospital, every open-heart surgeon in Rhode Island and physicians in the Koch Eye Associate that they will no longer be part of the plan’s network. Affected individuals can either find new physicians in the UHC network or change their insurance plans by Dec. 7.

Yesterday, we praised the state for its implementation of the state exchange, and we support its decision not to offer the problematic insurance fix that President Obama proposed last week. The state has also acted appropriately in this instance: Attorney General Peter F. Kilmartin and Health Director Michael Fine have written to United HealthCare criticizing the move and attempting to determine whether these changes will leave the provider capable of providing care for its Medicare Advantage patients. Unfortunately, as the two note, they do not have jurisdiction over the changes — United HealthCare’s plan falls under federal, not state, control. For that reason, we urge the company to reconsider or at least explain its cuts and to ensure that its Medicare Advantage Plan meets state seniors’ needs.

As Kilmartin and Fine note, United HealthCare has not clarified the details behind the rationale of a decision that could seriously harm many state residents. According to Rhode Island Public Radio, the two “admonish United for failing to explain in more detail why it dropped certain doctors,” writing that “limiting the number of doctors for Medicare patients in a state with such a high percentage of elderly people could affect patients’ ability to access and afford the doctors they need.” Furthermore, they protest that the insurance company did not inform patients directly, expressing worry that patients being treated will have difficulty transitioning care.

This situation is not specific to Rhode Island: The Florida division of UHC has removed about 45 percent of providers who were in its Medicare Advantage system, including the highly regarded Moffit Cancer Center. In Connecticut, the only nephrologist in the New Britain Region was removed, along with the more than 1,000 doctors in the Yale Medical Group, which comprises the faculty of the Yale School of Medicine. As Penn medical student and health policy researcher Miranda Rosenberg wrote in the Hartford Courant last week, “Based on the information available, it is clear that the company’s end goal is to unload its sickest, costliest patients.”

We worry that senior citizens enrolled in Medicare Advantage with United HealthCare will have insufficient resources to meet their needs, and we urge the state health director to continue to press the insurance company for more information. As the Rhode Island Medical Society told the Providence Journal, physicians from a host of specialties have been removed from the network: family medicine, general internal medicine, geriatrics, general surgery, otolaryngology, ophthalmology, cardiology, dermatology, endocrinology, pulmonology and rheumatology.  Given that these trends have been replicated in several states, it may be that federal oversight is necessary to ensure that companies like United HealthCare act in compliance with the law and can provide sufficient services for their patients.

The rollout of the Affordable Care Act in Rhode Island has been successful thus far, but it is situations like these — though out of the control of the state — that leave Rhode Islanders with insufficient care. We urge United HealthCare to respond to state demands to justify its cuts, and we encourage state health officials to continue their efforts to protect the 36,000 Rhode Island seniors enrolled in the company’s Medicare Advantage Plan.


Editorials are written by The Herald’s editorial page board: its editor, Rachel Occhiogrosso, and its members, Daniel Jeon, Hannah Loewentheil and Thomas Nath. Send comments to editorials@browndailyherald.com.