The Problem:

In many parts of the country, a few giant health insurance companies dominate the health care market place. When physicians attempt to negotiate patient care issues with these health plans, they are at a severe disadvantage.

• David versus Goliath
  Health insurance consolidation means market domination. Ironically, the antitrust laws – which were intended to protect the Davids of the world against the Goliaths – are having the opposite effect in the health care market. These laws make it virtually impossible for many physicians to negotiate with health plans over important patient care issues.

• Unreasonable contracts
  No reasonable businessperson would agree to such one-sided contract terms that are currently forced on physicians by health plans. For example, in Texas, a plan required physicians to pay for the cost of prescription drugs required by their patients if the cost exceeded $9000 per patient. Another unfair tactic often used by large insurers, known as the "all products" approach, forces physicians to accept unfavorable contract terms or risk being shut out of treating all patients covered by that health plan. Physicians have little choice but to go along.

• Millions of patients are losing their doctors
  In California, physician practices are filing for bankruptcy at an alarming rate. The California Medical Association predicts that 10 million patients risk delayed or interrupted care as a result. As history has shown, trends that begin in California often spread throughout the country over time.

• Quality of care is jeopardized
  As stated by the U.S. Department of Justice, "The acquisition would enable Aetna the ability to depress physicians’ reimbursement rates, which is likely to lead to a reduction in the quantity or a degradation in the quality of physician services to patients." United v. Aetna Inc. and The Prudential Insurance Company of America (1999). This is evident in California where some pediatricians only receive $10 per month for each patient, while data shows that the average monthly cost to care for a child in California is $24.10, and $47 nationally.

The Solution:

• Level the playing field
  Antitrust relief is needed to enable physicians and other health care professionals to effectively negotiate with health plans without fear of violating antitrust laws. Physicians should be allowed to negotiate contract terms that increase patient choice and improve quality of care. Patients and their physicians should make informed decisions about their health care needs, not insurers.

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