The South Dakota Senate firmly rejected a proposal attacking restricted “networks” of medical providers under health insurance plans Tuesday.
The so-called “any willing provider” proposal would have required health insurance plans to cover visits to any health care provider in the area who met the insurer’s “terms and conditions.”
Supporters said insurers are increasingly restricting their customers to a limited number of doctors. Particular ire was focused on the insurance plans run by large hospitals, who were accused of trying to force their customers to use the physicians and facilities run by those hospital chains.
“The big (hospital) systems are in the insurance business for one reason — to capture patients and market share, by undercutting competing insurance companies while making up the difference by funnelling patients to their employees,” said Sen. Phil Jensen, R-Rapid City.
Others focused on the consumers, saying this bill would let people keep their doctors if they changed insurance plans.
“Insurance providers are moving in and out of different areas,” said Sen. Corey Brown, R-Gettysburg. “As it occurs, I think it’s only fair that the patients, those who are insured, have the option to continue with the same providers they already have.”
But opponents fought back fiercely. Sen. Mark Johnston, R-Sioux Falls, said restricted networks serve a purpose — saving customers money.
“The more open the network, the higher the cost,” said Johnston, discussing an analysis of insurance options. “You have a totally open network, the premiums for that family were the highest… The more narrow the network, the lower the premium.”
Johnston, who works for Sanford Health, said the bill was being backed primarily by specialty hospitals, who he said had much higher profit margins than the community hospitals who oppose it.
Sen. Deb Soholt, R-Sioux Falls, said provider-run networks can mean more profits for those health care providers — profits that pay for the less profitable care they provide, such as charity care or treatment to people on Medicaid.
“Let’s keep a critical access hospital open in your community so your citizens have a place to go,” Soholt said. “Let’s provide the overarching shelter of overhead within other mechanisms so we can do economy of scale.”
Soholt works for Avera McKennan.
Sen. Bruce Rampelberg, R-Rapid City, said passing the “any willing provider” law would limit capitalism.
“Under the guise of fairness and patient choice, competing businesses are asking the Legislature… to enact laws in their favor rather than working to develop their own products,” Rampelberg said.
“The legislation embodies the meaning of the free market in the truest sense by fostering competition,” Jensen said.
But supporters of the “any willing provider” bill got outvoted two to one. The Senate rejected the bill 23-11, ending the fight for at least one year.