AWP laws require managed care plans to accept any qualified provider who is willing to accept the terms and conditions of a managed care plan. These laws do not require managed care plans to contract with all providers. However, they do require managed care plans to explicitly state evaluation criteria and ensure “due process” for providers wishing to contract with the plan.That same article from Health Affairs indicates that AWP laws increase administrative costs for managed care health plans (although only by a small amount) but substantially increase costs for services, because the plan may no longer use the exclusivity of being part of their provider network to get larger discounts from providers. At least when this study was printed in 1995, these were differences of as much as 20%.
Who benefits from AWP plans? I suppose patients benefit from having a wider range of available medical care providers at the preferred provider rate, and to the extent that it increases what providers can charge, doctors benefit from it. But it seems that it would drive up health insurance costs for managed care health plans, and that makes health insurance more expensive. Idaho is not the only state with an AWP law, as you might expect.
Now, if there were a political party in Idaho that was committed to free markets and capitalism, we could get the AWP law repealed. But that's a bit much to hope for, isn't it?
AWP laws lead to an increase in freedom. As it is, a business or consortium can conspire to control the market by refusing to allow doctors and hospitals into their network. The consumer or patient has no choice in the matter since they must do whatever their employer tells them. AWP laws would allow a patient to keep their doctor and still allow the HMO to set rates. The doctor or hospital could negotiate or accept the current rates which would put all on an equal playing field. Repealing AWP laws would restrict freedom of choice and freedom of contract.
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