CHICAGO – Action from payers, employers, organized medicine, and researchers can alter the mounting financial and clinical barriers patients face as a result of high-deductible health plans, according to new policy adopted by the nation’s physicians at today’s Special Meeting of the American Medical Association (AMA) House of Delegates. The new AMA policy outlines actions to promote innovative health plan designs and improve access to meaningful, affordable coverage.

As enrollment in high-deductible health plans has dramatically increased in recent years, more patients face significant out-of-pocket costs in the forms of copayment, coinsurance and pre-deductible expenses. The financial burden of these increased out-of-pocket costs causes many people to forgo necessary care, especially patients in marginalized communities or patients with multiple chronic conditions or lower socioeconomic status.

“The pandemic has prominently displayed the critical barriers posed by underinsurance, with many health plans not providing affordable coverage for services to treat chronic conditions and COVID-19- related illness,” said AMA Board Member Mario E. Motta, M.D. “The new policy encourages research and advocacy to promote innovative health plan designs that respect patients’ unique health care needs. Moreover, to ensure that innovative health plans are likely to achieve their goals of enhanced access to affordable care, the new policy encourages active collaboration among organized medicine and payers during plan development.”

AMA policy recommends a variety of actions that payers can take to soften the burden on patients of increasing out-of-pocket costs. Newly adopted AMA policy recognizes the unique role of employers as designers of health care benefits and outlines strategies they could use to offset the burdens of increasing out-of-pocket costs and ensure there is meaningful, affordable health insurance coverage for their employees.

The new AMA policy encourages employers to:

  • Provide robust education to help patients make good use of their benefits to obtain the care they need
  • Take steps to collaborate with their employees to understand employees’ health insurance preferences and needs
  • Tailor their benefit designs to the health insurance preferences and needs of their employees and their dependents
  • Pursue strategies to help enrollees spread the costs associated with high out-of-pocket costs across the plan year

The new policy encourages benefit designers to look beyond health plans with blunt instruments for shifting health care costs and builds on AMA’s continued support for tailored flexibility in health plan design that recognizes the same medical service could be high-value to one patient and low-value to another.

The AMA strongly believes that every American should have access to meaningful, affordable coverage. With the significant number of people who have lost health insurance coverage due to job cuts, the AMA continues to work on increasing awareness of options for subsidized coverage from the states and the federal government to ensure that fewer people fall through the cracks.

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About the American Medical Association

The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care.  The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.

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