When Obamacare handed insurance companies millions of compulsory customers, it also handed them a reminder of one of their industry's toughest realities: Consumers want low premiums, and they want to see any doctor they want. And it's impossible to give them both.
Generally, insurers selling plans on Obamacare's exchanges opted to keep premiums low, hoping the public would prefer a low upfront price tag — even if that meant customers couldn't always pick their first-choice doctor.
But "if you like your doctor, you can hope she's in our network" was always going to be a tough sell for insurers. With the insurance market now viewed through the distorted lens of the endless partisan fight over Obamacare, it's going to be harder than ever. Republicans have pounced on the narrow networks, citing them as further proof that President Obama lied when he said the Affordable Care Act would not cost people their doctors.
And as the volume of enrollees and rhetoric rises, insurers are worried about a possible backlash. Narrow networks are getting a bad reputation, and consumers may demand more choices.
It has happened before: In the 1990s, insurers hoped that by using health-maintenance organizations to move their coverage away from expensive doctors and hospitals, they could control health costs while creating an incentive for providers to lower their prices. What they created instead was a popular rebellion, with customers balking at the HMO plans and complaining loudly to Congress about it.