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The Next Big Obamacare Issue You Have Not Heard About...Yet

12/18/2013 04:27 pm 16:27:17 | Updated Feb 17, 2014

"If you like the plan you have, you can keep it." That pitch was one of the most effective arguments used by President Obama as he fought for health care reform early in his first term. In the past few weeks, however, it has become a major nuisance for both the president and supporters of the health law. After a wave of consumers saw their individual health insurance plans canceled by their insurers, the White House was forced to backtrack on that claim. Last month, the president offered a "fix"-- allow insurers the option of extending these canceled plans for up to one year.

This story has largely faded into the background as HealthCare.gov and state-based marketplaces have improved functionality and several insurers have re-offered previously canceled plans. But the claim that if you like your current health plan, you can keep it, was only part of the president's pitch. In a 2009 weekly address, President Obama said, "If you like the doctor you have, you can keep your doctor too." That is the phrase that is about to heat up the public debate.

Controversy Brewing

In the coming weeks and months, this statement will prove as controversial as President Obama's claim that you can keep your plan. Congressional Republicans are already planning, scheduling hearings and making statements to draw attention to it. Here is a quick breakdown of the debate to come:

Advocates of the law will argue that the president was being honest. His promise about keeping your doctor hinged on the growth of health insurance marketplaces -- online shopping platforms where consumers can learn about, compare, and purchase a health insurance plan. Through marketplaces -- including the federally run HealthCare.gov, state-based exchanges like Covered California, and private marketplaces like GoHealthInsurance.com -- consumers can inspect plan details and see whether their local doctor falls within a plan's network. Comparing the benefits of multiple plans including premiums, deductibles, AND physician and hospital networks is why we need marketplaces.

Opponents of the Affordable Care Act will likely argue the president's claim is false. They may point to individuals shopping through HealthCare.gov, who purchase a similar policy to the one they had previously only to find out that their doctor is no longer within that policy's network. Some, like House Speaker John Boehner, have gone further to say that the law is "causing people to lose the doctor of their choice."

The Key to Keeping Your Doctor

It is possible for consumers to keep their doctor under the Affordable Care Act. Doing so hinges on the consumers' ability to understand the complex details of different health insurance policies. While marketplaces allow consumers to compare top-line elements of health insurance policies, like price, deductible, and benefits, it may be more difficult to glean nuanced details like the physician network and covered elective procedures.

Good news for consumers: there are resources that can help compare plans and answer key questions like "is my doctor covered?" They are called health insurance agents and brokers.

Broker Benefits

Imagine you are shopping for an apartment in Chicago. You could shop on listing services like Craigslist, where you have to make a decision based on pictures, descriptions, and prices. Sure, you could visit the building, but how will you know if the neighborhood is safe? If you worked with a broker, the broker would use his or her expertise and show you some of the apartments that best fit your needs and wants. Best of all, in Chicago brokers are paid by the landlord, so their service is at no cost to you!

The same is true for insurance agents. Rather than shopping on your own, consumers can utilize agents' services at no cost because agents are paid by insurers. While you can shop on your own on a marketplace, insurance agents can help you understand your choices. For example, if you have lots of prescriptions, the agent can show you only policies with good prescription benefits. If you want to stay with your doctor, an agent can show you only policies that have your doctor in their network.

Agents and brokers are licensed by the states in which they do business and must be approved by the insurers whose products they sell. Both state licensing and insurer appointments are involved processes that help protect consumers from dealing with agents lacking training or certification.

In the coming weeks and months, there is sure to be controversy about the president's "keep your doctor" claim. Regardless of which side is right, agents and brokers are already working to make sure the consumer does not suffer. Consumers purchasing individual insurance can make sure their doctor's services are covered in their plan by working with a health insurance agent or broker.