If you have a health care provider you really like, look very carefully at any plan you buy on HealthCare.gov. To keep costs down—a top Obama administration priority—insurers on the government's health care exchange are offering smaller networks that cut out the country's most prestigious (and most expensive) hospitals and doctors, the Washington Post reports. In one much-watched case, the Seattle Children's Hospital has filed a lawsuit against Washington's insurance commissioner over all the plans excluding it. It's an especially expensive hospital, the region's top insurer explains; a pediatric appendectomy there costs $23,000, compared to $14,100 at another local hospital.
The Affordable Care Act requires plans to include enough providers to guarantee quality care, but offers no guidelines on what that entails. Some hospitals, such as the Cleveland Clinic, are pulling themselves off of plans, complaining that the reimbursement rates are too low. Some experts actually argue that these splits are good things—top-flight hospitals provide essential services, they explain, but routine care can be had elsewhere at a cheaper cost. But critics say these moves are producing a two-tiered system, and creating real dilemmas for families like Jeffrey Blank's; his daughter has a rare bone disorder, and is used to getting routine checkups from Seattle Children's.