My last two posts dealt with the new Health Insurance Exchange, or “Marketplace,” which opened yesterday, and I talked about some of the concerns with the limited options and a limited provider network. What will be the impact for 2014 for our patients and costs? I heard from several of you with your ideas and concerns and thought I would share them with you today.


Many shared their concerns that the limited network and insurance options can disrupt patient-doctor relationships, as it would make seeking care inconvenient and potentially dangerous if the driving distance is too far.  As I think about choice in health care, I believe that patients care more about their choice of physician than their choice of insurance, but a limited network puts that question to the test. Choice of a plan or insurer gets complicated when cost becomes a variable. Some have argued that we should stay out of this and let the market develop over the next two to three years. Others have said that we should push to expand the current exchange network to better meet the needs of people across the state and minimize the disruption of patient-physician relationships.

Still, others have advocated for moving away from a market-based solution and pursuing a single-payor system. Several have forwarded an editorial written by two physicians in The New York Times that argues that a single-payor system would enhance choice of physician or hospital and reduce administrative costs. Read more


What should NHMS do to sustain the patient-physician relationship, promote choice in a patient-centered way and work to contain costs in the context of the current law and healthcare reform environment?  Please send your questions or comments to or post a comment below.