One point Laszewski does not make clearly enough is that not only do the new insurance plans have restricted networks; many (my limited research indicates most) of them also do not have any out-of-network coverage other than emergency care. None. Zip, zilch, nada. Niente. So when Laszewski says (emphasis mine):
... some health plans are only offering narrow networks on the new health insurance exchanges. Health plans, figuring that a great many of the new exchange customers will be coming from the ranks of the uninsured have decided to craft plans that largely include providers located where many of these uninsured people live and where they are most likely to get their health care anyway––perhaps not as big a deal for these folks who, because they are uninsured, don't have a regular provider relationship. But it also means these people will not have access to some of the most respected centers of excellence if they have a serous illness. [snip]
People who might be accustomed to broader networks found in employer health plans will have to either buy-up to better plans or may find their choices limited on the exchange.
it isn’t just that people will have to buy a more expensive plan to get a broader network; it’s also that people will have to buy a more expensive plan to get any coverage for out-of-network treatment at major cancer centers, well-regarded children’s hospitals, specialty diagnostic facilities - all kinds of “respected centers of excellence”.
Do people without out-of-network coverage still have “access” to these facilities? Of course, if by access one means they can show up and ask to be treated. But if by “access” one means actually receiving treatment at these facilities without insurance coverage - well, if people could get expensive medical treatment without being able to pay for it, no one would need health insurance in the first place.