If nothing else, the public outrage over those individual health insurance policy cancellations last fall served to remind or enlighten consumers about health coverage: that coverage is offered on a one-year basis; renewal is not guaranteed; and insurers can indeed withdraw plans with timely notice.

While a widespread cancellation of policies by numerous carriers is as rare as a Chicago Cubs World Series victory, this one was both routine and widely predicted, given the new plan requirements of the Affordable Care Act. Simply put, most of the canceled plans no longer measure up.

But while pundits were busy portraying these cancellations in Hindenburg terms (“Oh, the humanity!”), a similar spate of “hidden” cancellations quietly continues in hospitals and insurance companies across the country that may have far greater impact on your health care than last fall’s pruning.

Of big fish and little fish

Here’s what’s happening: The little fish (self-employed doctors and small clinics), increasingly squeezed by the cost to transition from fax machines to 21st century technology, are being swallowed by the big fish (large medical groups and hospitals) with the wherewithal to do so.

Health insurers are similarly trimming small providers from their networks and opting to contract with the larger fish, which can offer them better terms because they have the enhanced technology to meet the new quality standards and thus reap top dollar from government programs such as Medicare. And as Medicare goes, so goes America’s health care system.

“Now, if Aetna contracts with the major hospital as their preferred provider, it comes with their physicians — it’s all a package now,” explains Deborah Chollet, senior fellow at Mathematica Policy Research in Washington, D.C. “That’s what the hospitals have wanted, because the hospitals can negotiate much better rates with that package than without.”

How is this likely to impact you? Simple: your insurer might drop your doctor.

The doctor isn’t in

Right now, the pruning is most visible in Medicare Advantage plans. According to Kaiser Family Foundation, health care giant United Healthcare served notice this fall that it’s dropping 2,250 physicians in Connecticut, 2,100 in New York City, and entire prestigious practices, including the 1,200-physician Yale Medical Group and the 250-physician Moffitt Cancer Center in Tampa, Fla, the only National Cancer Institute-designated cancer treatment facility in Florida.

Where’s all the screaming about these cancellations? So far, the American Medical Association and 42 medical specialty and patient advocacy groups have appealed to Medicare to intervene. But, as with those individual policy cancellations, an insurer is perfectly within its rights to prune doctors from its network with 30 days’ notice to its members.

“The narrower choice of doctors is something that’s going to shake out over the next couple of years, and it really has nothing to do with the Affordable Care Act,” says Chollet. “It has to do with industry trends and reorganization within the industry.”

As President Barack Obama famously said, “If you like your doctor, you can keep your doctor.”

That is, if he or she is still in network.

Follow me on Twitter: @omnisaurus.

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