AMA House of Delegates

Doctors seek role on insurance exchanges

The AMA also adopts recommendations calling for patient choice of physician to be protected.

By Charles Fiegl — Posted Nov. 28, 2011

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The American Medical Association outlined recommended standards and safeguards to protect patients and physicians, as states develop marketplaces for purchasing health insurance under the national health system reform law.

An AMA Council on Medical Service report advocating for strong patient and physician protections in state-run exchanges was adopted by the House of Delegates during its Interim Meeting in November. The report calls for the inclusion of physicians and patients in the governance structures for the exchanges.

"If they are developed well, health insurance exchanges will provide a new way for millions of Americans to obtain health care coverage from private insurers," said AMA Board of Trustees Member Barbara McAneny, MD, an oncologist from Albuquerque, N.M. "Physicians and patients should be involved in setting up and governing these bodies to ensure they best meet the health care needs of residents in each state."

The development of state-run exchanges is a key part of the health reform law, which will expand insurance coverage to an estimated 30 million individuals starting in 2014. Americans without insurance would use exchanges to select plans from a variety of coverage options.

Medical association role

The AMA will advocate that state medical associations assist in the development of the insurance marketplaces, according to the report. Donna Sweet, MD, an internist in Wichita, Kan., who is chair-elect for the Council on Medical Service, noted that the Dept. of Health and Human Services will implement a federal exchange in states that don't have their own in place by 2014.

"State exchanges need to be in place; if not, the feds will be much more involved," she said.

Exchanges also must address patient churning among health plans, the report said. The AMA called for systems that allow for real-time patient eligibility checks for medical practices.

Delegates reaffirmed AMA policy that strongly opposes the use of taxes or fees on physicians and other health professionals to fund exchange platforms. Insurance offered on exchanges also should not require physician participation or exclude patient access to specialty care, delegates agreed.

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