UNEXPECTEDLY: Offering Poor Value, Obamacare Exchanges Have Become Medicaid-like Ghettos. “To moderate premium spikes, insurers have done what Medicaid managed-care plans do: Narrow networks. Consultants at McKinsey note that three-quarters of exchange plans in 2017 will have no out-of-network coverage, except in emergency cases. And those provider networks themselves are incredibly narrow: one-third fewer specialists than the average employer plan, and hospital networks continuing to shrink. In short, exchange coverage looks nothing like the employer plans that more affluent Americans have come to know and like.”