News & Commentary

Top-ranked hospitals getting pickier about ACA plan networks


Almost all of the top-performing regional hospitals in the country are available to consumers purchasing health coverage on the ACA exchanges, according to a report by the Robert Wood Johnson Foundation. The foundation looked at the 156 regional hospitals that made the U.S. News and World Report list of best regional hospitals last year and found that 96% were in the network of at least one of the 2016 plans sold on the exchanges.

Marketplace plan network participation by regionally ranked hospitals

Source: Robert Wood Johnson Foundation, “Most Regionally Ranked Hospitals Stay in-Network With Marketplace Plans, But Participation Declines,” Feb. 23, 2016

That finding may allay some of the concern that people who buy plans sold on the exchanges are stuck with narrow networks with inferior hospitals.

But there are plenty of caveats—so many, in fact, that a rosy appraisal really isn’t warranted. For one thing, the foundation’s report doesn’t distinguish between gold, silver, and bronze plans. Plans with the top-ranked hospitals may be more expensive.

Consider also that the proportion of hospitals in the network of only one plan sold on the exchanges increased from just 7% in 2015 to 20% in 2016. For example, the University of North Carolina Hospital was in four ACA plan networks in 2015 and is in only one this year. Moreover, more than half of these well-regarded hospitals reduced the number of networks they belonged to, and some important hospitals are not in any ACA plan networks in 2016—including New York University Langone Medical Center, the Mayo Clinic’s hospital in Phoenix, and University of Texas Southwestern University Hospital in Dallas.