CHICAGO — Faced with federal and state actions that have the potential to cause instability in the Affordable Care Act marketplaces, the American Medical Association (AMA) announced its opposition to health insurance plans being sold in the individual and small group markets that do not guarantee critical patient protections under the ACA.
The AMA believes that all plans sold to individuals and small groups should guarantee pre-existing condition protections and coverage of essential health benefits and their associated protections against annual and lifetime limits, and out-of-pocket expenses. The exception is in the circumstance of short-term limited duration insurance offered for no more than three months.
“The AMA knows that insurers are more likely to participate in marketplaces with large and healthy risk pools. 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,” said AMA President David O. Barbe, M.D. “At some point, people who are currently healthy are going to have to seek medical care, and we need to make sure that they avoid sham coverage that does not provide them with the coverage and financial protection they counted on at the time of enrollment.”
With threats to the ACA marketplaces emerging and concerns that insurers are going to pull out of some ACA marketplaces, the AMA agreed with the sentiment that a back-up plan needs to be available to ensure patients are not left without coverage options. In counties that lack a marketplace plan, the AMA supported requiring the largest two Federal Employees Health Benefits Program (FEHBP) insurers to offer at least one silver-level marketplace plan as a condition of FEHBP participation. Of note, this new policy would not allow individuals to buy-in to FEHBP plans. Rather, individuals in otherwise bare counties would have the choice of at least two silver plans that abide by ACA requirements, offered by the two largest FEHBP insurers in their county.
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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.
