Health System Reform Insight - Oct. 6, 2011
Given the new direction for the nation’s health system, the AMA has developed Health System Reform Insight to help you understand what this new direction means to you and your patients.
As implementation of the Affordable Care Act (ACA) continues to move forward, health insurance exchanges remain a focal point for both federal and state policymakers. At a minimum, exchanges should be consumer-friendly venues for patients to purchase health insurance, but they have the potential to do much more.
If implemented properly, they should help to provide affordable coverage to millions of uninsured Americans and help offer patients greater choice in their health insurance purchasing options. This last point is particularly important since so many health insurance markets across the country are dominated by one or two major health insurers, to the detriment of patients and physicians.
The ACA calls for exchanges to be operational in all 50 states and the District of Columbia by Jan. 1, 2014. Twelve states—Colorado, Connecticut, Hawaii, Illinois, Maryland, Nevada, North Dakota, Oregon, Vermont, Virginia, Washington and West Virginia—have enacted laws this year either establishing or calling for a study of exchanges.
Another handful of states—Alabama, Georgia, Indiana, Mississippi and Rhode Island—have begun varying levels of exchange implementation based on executive orders. California enacted exchange legislation in 2010, and Massachusetts and Utah passed exchange legislation before the ACA was enacted. If states do not establish an exchange, the federal government will assume this responsibility.
The AMA has prepared a discussion paper to assist states with implementing exchanges. In the paper, the AMA recommends that:
- Exchanges should include practicing physicians and patients in their governance structure.
- All qualified health plans should be allowed to participate in an exchange in order to increase competition in health insurance markets.
- Qualified health plans should be required to maintain adequate physician networks and not restrict enrollees' access to out-of-network physicians.
- Exchanges should not mandate physician participation in Medicaid or qualified health plans sold on an exchange.
The AMA is reviewing several proposed federal regulations aimed at helping to shape the state exchanges. It is clear from the proposed regulations that the federal government is providing states with discretion on several key points, including establishing an open marketplace or active purchaser model, how to define network adequacy, who should serve on exchange governance boards and how to finance exchanges.
The AMA is working on comments in response to the proposed regulations. Watch Health System Reform Insight and other AMA communications for updates.
AMA members can hear the latest news about the Joint Select Committee on Deficit Reduction, and share a question or comment with AMA President Peter W. Carmel, MD, during the next Office Hours with Dr. Carmel conference call, which will take place at 7 p.m. Eastern time. Register today.
Physicians who wish to file for an exemption from the 2012 ePrescribing penalty must apply by this date. Submit an application. If you have difficulty accessing the online application, email QualityNet, which runs the portal.
The Joint Select Committee on Deficit Reduction is due to approve a proposal to reduce federal spending by at least $1.2 trillion. Tell Congress that repeal of Medicare's flawed sustainable growth rate formula must be part of the committee's proposal.