The American Accademy of Family Physicians (AAFP) has outlined where it stands on the Senate Health, Education, Labor and Pensions (HELP) committee's health reform bill titled the Affordable Health Choices Act.
Here's a look at how the AAFP responded to the idea of including a publicly funded insurance option found in the bill:
Section 3101 Affordable Choices of Health Benefit Plans
This section allows each state to have an "Affordable Health Benefit Gateway" to "facilitate the purchase of health insurance at an affordable price by individuals and groups." This includes qualified health plans, Medicaid, CHIP and other federal programs.
AAFP position: The AAFP supports the flexibility for each state provided later in Section 3104. We also agree with the requirement that the federal government step in after four years to establish a gateway if a state has not done so.
While we realize the concept of a public plan option is undergoing serious discussion, and that many alternatives still are being explored, the AAFP recently approved a position to support the concept of a public health plan option under certain conditions.
- The administrators of the public plan must be accountable to an entity other than the one identified to govern the marketplace.
- The public plan cannot be Medicare.
- The new public plan must be actuarially sound.
- The public plan cannot leverage Medicare (or any other public program) to force providers to participate.
- The public plan should not be required to use Medicare payment rates.
- The insurance market rules and regulations governing the public plan must be the same as those governing private plans.
- The public plan cannot be granted an unfair advantage in enrolling the uninsured or low-income individuals who will presumably be eligible for subsidies in the new marketplace.
- Public and private insurers should be required to adhere to the same rules regarding reserve funds.
- The public plan would also need to contribute to value-based initiatives that benefit all payers.
In addition, the AAFP also supports the concept of a national health board, with independence and authority, which would oversee a new public health plan if implemented and eventual oversight of all public health plans with a composition to be determined from the public/private sector but not being fully government-based."
AAFP position: Regarding health information technology, the AAFP strongly supports interoperability, and, as such, supports provisions requiring the Secretary to consult with the National Coordinator for HIT to develop interoperable, secure standards and protocols that help individuals enroll in federal and state health and human services programs. Regarding Gateways, specifically, we support the use of an Internet website to allow state residents to identify one in their state.
AAFP position: Regarding "criteria for certification," the AAFP supports the use of regulations to establish criteria to certify health plans as "qualified health plans." These plans would be required to provide coverage for essential health care benefits.