AMA Wire

Wednesday, Aug. 15, 2012

Special Feature

New policy guides give physicians a voice on how ACA is implemented in their states

New policy guides give physicians a voice on how ACA is implemented in their states

Now that many provisions of the Affordable Care Act (ACA) have been upheld by the U.S. Supreme Court, the scene shifts to the states, which have some latitude in how the law is implemented for patients and physicians.

You can influence how key insurance provisions of the law are put into practice in your state using a new series of AMA policy guides. The series, "Improving the Health Insurance Marketplace," highlights specific topics and actions that can help promote a strong health insurance marketplace that benefits patients and physicians.

The series consists of 10 one-page policy documents and covers the following AMA recommendations:

  • Provide tax credits or other subsidies to individuals and families for the purchase of health insurance.
  • Establish open health insurance exchanges.
  • Support requiring individuals to obtain health insurance coverage.
  • Support coverage of pre-existing conditions with guaranteed issue and renewability.
  • Support modified community rating.
  • Maintain a strong medical loss ratio standard.
  • Continue the operation of high-risk pools.
  • Appropriately define essential health benefits.
  • Encourage the appropriate use of patient navigators.

How the ACA insurance provisions are implemented in the states impacts delivery of care and insurance coverage for your patients. An example is the way states define essential health benefits; how these benefits are defined will strongly impact health care premiums and costs.

That's why, as the AMA suggests in one of the policy guides, the criteria for defining essential health benefits for adults need to be flexible. This will ensure that patients can choose their own health plan and their respective benefits covered, and still get meaningful coverage. Benefits for children, on the other hand, should meet more robust standards.

Use the policy guides to lobby your legislators and work with your state medical society to make sure that your patients have the health insurance coverage they need, at prices they can afford. Doing so can help ensure that the health insurance marketplace works best for them—and you.