Network adequacy concerns are starting to generate renewed interest in new health plan provider mandates.
In November, voters in South Dakota will consider a ballot proposal to implement an "any willing provider" law, which would require insurers to contract with any licensed medical professional willing to accept their rates.
Any willing provider laws first evolved along with concerns about managed care in the 1980s. Today, 17 states have similar laws applying to physicians or hospitals and another 10 states require contracts with pharmacies.
While interest in the laws declined in the 2000s and some were invalidated, they are getting a second look amid the trend toward more limited networks in commercial and Medicare Advantage plans -- with South Dakota as the latest battle ground.
The state legislature rejected a bill that would have created an any willing provider system. But Stephen Eckrich, MD, an orthopedic surgeon, sponsored a new ballot initiative after seeing more patients with narrow and tiered networks travelling longer stretches for in-network provider visits, and after some long-time patients had to change providers or pay out-of-network rates.
The debate over the initiative, called Initiated Measure 17, has the South Dakota Medical Association favoring the measure and insurers such as Wellmark partnering with large health systems including Avera Health and Sanford Health to oppose it.
Wellmark, Avera, Sanford and others, including America's Health Insurance Plans, are waging a media campaign called "No to higher costs," to convince South Dakotans to vote against the measure.
"Initiated Measure 17 will create one more level of unnecessary government control over healthcare," the coalition argues. "It is big government stepping in and requiring that all providers who meet certain conditions be wedged into cost-effective coverage networks. Such government interference destroys all incentives for providers to offer lower rates."
The research on any willing provider laws are mixed.
Eckrich and other supporters argue that they're not as onerous to health plans as they appear, while opponents like AHIP and the South Dakota coalition point to the studies finding a slight uptick in prices for pharmacy spending following enactment of the laws.
Either way, the laws like the one proposed in South Dakota could create concerns for insurers, including for health plans sponsored by health systems -- especially since narrow networks are a central feature of public exchange plans.
Any willing provider laws interfere "with health plan efforts to create provider networks that deliver greater efficiency and higher quality," warns University of Southern California economist Paul Ginsburg, in a study sponsored by AHIP.