AMA seeks to boost affordability, competition in ACA marketplaces

Andis Robeznieks , Senior News Writer

To build upon the progress of almost 12 million people having obtained coverage through the Affordable Care Act (ACA) marketplaces this year, the AMA House of Delegates adopted policy aimed at increasing that number by taking steps to make marketplace plans more affordable.

Additionally, new policy was adopted that opposes the sale of individual and small group policies that do not guarantee pre-existing condition protections and coverage of essential health benefits (with the exception of insurance plans of three months or shorter). The policy notes that the coverage of essential health benefits is linked to protections against annual and lifetime limits, and out-of-pocket expenses.

Delegates followed recommendations contained in an AMA Council on Medical Service report on improving affordability in the health insurance exchanges to adopt policy that called for the AMA to support:

  • Providing adequate funding for and expansion of outreach efforts to increase public awareness of advance premium tax credits.
  • Expanding eligibility for premium tax credits up to 500 percent of the federal poverty level.
  • Providing young adults with enhanced premium tax credits while maintaining the current premium tax credit structure which is inversely related to income.
  • Encouraging state innovation—this includes consideration of state-level individual mandates and auto-enrollment and/or reinsurance— to maximize the number of individuals covered and stabilize health insurance premiums without undercutting any existing patient protections.
  • Establishing a permanent federal reinsurance program.

“We must build on the gains of the Affordable Care Act and make coverage more affordable for Americans by extending the eligibility for premium tax credits and increasing tax credit amounts for young adults that will result in greater coverage,” said AMA President David O. Barbe, MD, MHA.

The council report cited the need for outreach to increase the number of people insured in order to balance the individual market risk pool by increasing overall marketplace enrollment.

The report also noted the concern that the elimination of the federal individual mandate penalty has the potential to cause premium increases, coverage losses and market instability. State-level innovations such as state-level individual mandates and auto-enrollment were cited as potential paths forward.

The new policy on coverage protections originated from a separate council report that studied marketplace competition and health plan choice. It noted that for about 26 percent of marketplace enrollees have only one insurer on the marketplace from which to select plans.

“The Council is concerned with the potential for some state and federal activities to lead to market segmentation, with healthier individuals enrolling in skimpier plans, and with individuals who for health and other reasons enroll in plans following Affordable Care Act requirements,” the report states. “As a result of such adverse selection, there will likely be increased costs for individuals in plans following ACA requirements, resulting from sicker risk pools.”

Dr. Barbe echoed these points and noted the need to protect patients “from sham coverage” that does not provide the coverage they expected when they enrolled.

“The AMA knows that insurers are more likely to participate in marketplaces with large and healthy risk pools,” Dr. Barbe said. “We need to take steps to ensure that healthy individuals stay enrolled in coverage offered in the ACA marketplaces and are not siphoned off into coverage that does not guarantee critical patient protections, leaving behind a sicker population facing higher premiums in ACA-compliant coverage.”

Read more news coverage from the 2018 AMA Annual Meeting.