Insurers are facing Pressure to increase choices of Doctors and Hospitals

Insurers are facing pressure from regulators and lawmakers about plans that offer limited choices of doctors and hospitals, a tactic the industry said is vital to keep down coverage prices in the new health law's marketplaces. 

This week, federal regulators proposed a tougher review process for the doctors and hospitals in plans to be sold next year through HealthCare.gov, a shift that could force insurers to expand those networks.

Meantime, regulators in states including Washington and New Hampshire are ramping up their own scrutiny, and lawmakers in Mississippi and Pennsylvania, among others, are weighing bills that could force plans to add more hospitals and doctors. 

The moves come amid complaints by some consumers that they don't have access to a broad enough range of care—such as specialists at top academic medical centers, which tend to charge insurers higher fees and aren't included in many of the new networks.

Some consumers say they will have to switch doctors with the new health-law plans. But the issue extends beyond the new policies, as insurers have been trimming the array of doctors in private Medicare Advantage coverage and losing some big health-network providers due to market clashes. 

California Insurance Commissioner Dave Jones said he plans to revise his agency's standards for insurers' health networks partly because current regulations don't give him enough power to continue oversight after a health plan goes on the market. The aim would be to "make sure when people purchase health insurance, they have reasonable access to health-care providers," he said.

Under the new federal proposal, insurers selling plans in the federally run marketplace would be required to submit to the Centers for Medicare and Medicaid Services a full list of providers in a network before their plans are approved for listing in the exchanges. In the future, regulators also plan to develop federal standards for the required number of providers. For this year, the federal exchange relied largely on state regulators and third-party organizations to review networks, said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.

"It's a substantial change," said Ms. Pollitz. "It's much more specific, and it's going to involve a lot more direct federal oversight." 

Under the proposal, the plans offered in the federally run insurance marketplace also would need to include a larger share than previously required of "essential community providers," which are safety-net hospitals, clinics and others often used by lower-income people.

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