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ACA State Implementation

The new health insurance exchanges, created by the Affordable Care Act (ACA), will provide a marketplace that allows individuals and families to find coverage that fits their budget and their needs. The enrollment period ends on March 31, 2014.

As part of the AMA's work on state implementation of the ACA, the ARC has identified the following areas for legislative, regulatory and communications-related advocacy.

  • Directly advocating AMA policy to state policymaking organizations (e.g.the National Association of Insurance Commissioners) to help influence regulatory and legislative policies.
  • Updating existing resources that can be tailored for medical society advocacy.
  • Developing new resources to address specific areas of concern for physicians.
  • Working with the the AMA’s Washington, D.C. staff on enrollment and other areas.

Health Insurance Exchanges Overview

The Affordable Care Act (ACA) has changed the way health insurance will be provided and paid for in the United States. One of the biggest changes under the ACA is now in effect, with many people covered under the new health insurance marketplaces.

ACA State Implementation Toolkit

As state implementation of the ACA and health insurance exchanges raise new issues, model legislation from the AMA is helping to bring clarity to this evolving landscape and protect patients and physicians. The AMA’s model bills on narrow and tiered networks, the grace period and fair contracting practices lay the groundwork for medical society advocacy on state exchange implementation. In addition, physicians may be asked to sign new contracts as a condition of treating patients within the structure of the ACA. The Health Insurance Exchanges State Implementation Transparency Campaign also can help physicians and medical societies advocate for fair contracting provisions within the exchanges by identifying the issues physicians are facing today.

ACA-related Issue Briefs

The AMA Health Policy unit has prepared a series of issue briefs, "Improving the Health Insurance Marketplace," highlights specific topics and actions that can help promote a strong health insurance marketplace that benefits patients and their physicians.

You can view all of the ACA-related issue briefs at www.ama-assn.org/go/healthpolicy

ACA-related Correspondence

Following passage of the ACA, the AMA commented extensively to help guide the rulemaking process.  Comments focused on areas including:

  • Administrative Simplification
  • Antitrust Relief and Removal of Other Legal Barriers
  • Consumer Health Plan Appeals
  • Coverage of Preventive Services
  • Dependent Coverage of Children Under Age 26
  • Essential Health Benefits
  • Medicaid
  • Medical Loss Ratios
  • Physician-Owned Hospitals
  • Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions and Patient Protections
  • Public Reporting and Data Release

You can read the letters about these topics and more at www.ama-assn.org/go/acaregs

Pended Claims and the Medical Loss Ratio

Pended Claims. Under the Affordable Care Act (ACA), patients who receive Advance Premium Tax Credits have a 90-day grace period to catch up on paying delinquent premiums. During the first 30 days of this period, plans are required to continue paying claims; but during the subsequent 60 days plans may designate claims as pending and ultimately deny payments if premiums are not paid. The AMA continues to advocate to the Administration, and also is working with state medical societies on possible, state-based solutions.

Medical Loss Ratio. The AMA believes that patients deserve to get the maximum value from their health insurance premiums, and requiring that at least 80 percent of the patients' premium dollars be spent on medical care can help accomplish this goal. Learn more about AMA advocacy for a strong medical loss ratio, which has required insurers to provide more than $500 million in rebates to individuals and families for 2011-2012.

Public Health Initiatives

There are many public health initiatives contained into the Affordable Care Act (ACA). These measures focus on wellness and prevention as well as initiatives to improve the quality of health care.  Much of the ACA public health provisions focus on promoting preventive services by requiring insurers to cover certain preventive measures and allowing insurers to create wellness incentive programs.

Reforming Medicaid

The Affordable Care Act (ACA) significantly expands those covered by Medicaid.As a result of the new law, Medicaid must cover all non-Medicare eligible individuals under 65 years of age with incomes up to 133% of the federal poverty level (FPL) based on modified gross income.Through this change, Medicaid is expected to cover an additional 16 million people by 2014.The ARC will work to facilitate communication, strategies and information-sharing among federation organizations on issues relating to state implementation of the Medicaid provisions of ACA.

AMA Reforming Medicaid Campaign: A comprehensive state campaign focused on issues including but not limited to physician reimbursement and access to care, preventing mandatory participation requirements and Medicaid recovery audit contractors (RACs) and dual eligibles.

Physician-led Teams

As millions obtain health insurance and can access ongoing health care as a result of the ACA, the AMA supports physician-led health care teams that ensure health care professionals work together to meet the surge in demand. The AMA is working to ensure sustainable physician practices that result in better health outcomes for patients, and having more physician-led health care teams will help us achieve these goals.

The ACA has inspired new health care delivery system reforms that hinge on a team-based approach to care. In the physician-led team approach, each member of the team plays a critical role in delivering efficient, accurate, and cost-effective care to patients. With seven years or more of postgraduate education and thousands of hours of clinical experience, physicians are uniquely qualified to lead the health care team. Physicians, physician assistants, nurses, and other health care professionals have long worked together to meet patient needs for a reason: the physician-led team approach to care works.

Campaign resources