Physicians advocate to protect meaningful health insurance coverage for patients and promote stable health insurance premiums

HONOLULU — Patients must have meaningful coverage for hospital, surgical and medical care and protections against catastrophic expenses, according to physicians gathered at the Interim Meeting of the American Medical Association (AMA). Taking a step to ensure quality health insurance coverage for their patients, physicians voted to oppose weakening or removing any of the 10 categories of essential health benefits (EHB) required by the Affordable Care Act (ACA).

The new policy was recommended by a report from the AMA’s Council on Medical Service, which noted, “if insurers are allowed to offer plans with skimpier coverage, plan designs could potentially discriminate against people with pre-existing conditions. In addition, individuals who use services and benefits no longer included in the EHBs could face substantial increases in out-of-pocket costs.”

According to newly adopted policy, the AMA will oppose the removal of categories from the EHB package. In addition, the AMA will also oppose waivers of EHB requirements that lead to EHB categories and their associated protections against annual and lifetime limits, and out-of-pocket expenses, being eliminated.

“Most costs associated with EHB requirements are attributable to such services as hospital inpatient and outpatient care, physician services, and prescription drugs. These services are fundamental components of health insurance coverage,” said AMA President David O. Barbe, M.D. “Removing any categories from the EHB requirements, or allowing waivers of such requirements, could make individuals vulnerable to significant out-of-pocket expenses, or hinder patient access to necessary services.”

Analyses have found that categories most likely to be removed from the EHB, if states are allowed flexibility to do so, include maternity care; mental health and substance abuse benefits; rehabilitative and habilitative services; certain pediatric services, including oral and vision care; and prescription drugs.

Physicians at the AMA Interim Meeting also evaluated various options to improve the stability of health insurance premiums by subsidizing the costs of high-cost and high-risk patients, who may have pre-existing conditions. Physicians favored directing resources to reinsurance programs given evidence that other programs involving high risk pools before the Affordable Care Act provided second-class insurance to individuals with pre-existing conditions. Newly adopted AMA policy prefers reinsurance programs as an economical and equitable mechanism to subsidize the expenses of high-cost and high-risk patients.