Right-wing media distorted an AP story about narrow health care networks to falsely claim that most or all enrollees in the Affordable Care Act's (ACA) exchanges cannot access elite cancer treatment facilities.

On March 18, the AP released the results of a survey it had conducted which found that access to cancer centers such as New York's Memorial Sloan-Kettering and Houston's MD Anderson would be restricted for some patients who purchased coverage on the ACA's health insurance exchanges.

Right-wing media outlets distorted the story with headlines like the New York Post's “Nation's elite cancer hospitals off-limits under Obamacare.” Fox News' Fox & Friends highlighted the story as well, but deceptively omitted some of the AP's wording to claim only four cancer centers could be accessed through coverage purchased from the ACA's exchanges:

Nothing in the AP report says that any of the cancer treatment facilities are excluded from all of the exchange plans in a given state, like the New York Post and Fox suggest. 

What's at issue is a reality of the health insurance industry known as narrow networks. Narrow networks generally offer patients more affordable coverage but provide coverage at fewer hospitals and doctors. While the ACA is having an impact on narrow networks, they existed before the law was implemented as a way for insurance companies to control costs. The truth is that a hospital being included in a particular plan's network is a decision that's made between the provider and the insurance company, and the choice to restrict access to certain providers, especially high-cost providers, is one that insurance companies have been making for decades.

In a November 2013 post for The New Republic, Jonathan Cohn pointed out that “Insurance companies have been using limited provider networks for a long time. It's how they conducted business before Obamacare came along and, for better or worse, it's how they'll conduct business now that Obamacare is law.” Cohn noted that Obamacare is having an impact on narrow networks, but they are largely a choice by insurance companies, one that is a result of market forces:

With Obamacare, and its requirement of selling policies to anybody willing to buy them, insurers also worry about adverse selection. Previously, they were willing to offer plans without provider restrictions, but only to people unlikely to use either outpatient or inpatient services much. Now insurers have to sell plans to anybody, regardless of pre-existing conditions or risk of illness. In other words, they can't restrict wide-open access to the people least likely to use it. Faced with this reality, some insurers are bound to raise premiums for those plans--or to stop offering them altogether. That's why some people who buy these plans now would have to pay more for them next year. (Basically, this is just another form of rate shock, about which you've read so much already.)

Still, according to nearly every source inside and outside the industry I've consulted, the primary reason carriers are offering so many small-network plans in the exchanges is that they believe consumers want them. Their marketing research suggests that, when forced to choose between paying higher premiums for wider networks or lower premiums for narrower networks, the majority of people will go for the cheaper insurance. The one survey I've seen on this question, by Morning Consult, suggests the carriers may be right: In that survey, nearly 60 percent of respondents said they'd opt for plans with fewer provider choices if meant saving on premiums.

Cohn also quoted Larry Levitt, the senior vice president of the Kaiser Family Foundation, who noted that “The main way insurers control costs is by negotiating and selectively contracting with doctors and hospitals. That's been the case for decades. The only real connection to the Affordable Care Act is that the health reform law is making insurers compete for customers more aggressively.”

While it is true that Obamacare is having an impact on narrow networks, it's also the case that the law dramatically increases access to care for cancer patients. The law's provision outlawing discrimination against pre-existing conditions arguably benefits cancer patients more than any other group. The law also provides premium protection for people with health conditions, removes lifetime and annual limits on benefits, and expands cancer screening and other preventive measures. The American Cancer Society endorsed the law and has written extensively on the benefits of the law for cancer patients, including listing six ways Obamacare “will meaningfully improve the health care system for people touched by cancer.”