Public Release: 

ACP to Senate: Efforts to stabilize health insurance markets should first, do no harm

American College of Physicians

Washington (September 14, 2017) The American College of Physicians (ACP) told the Senate today that any reforms being considered to help stabilize the health insurance marketplaces should first, do no harm to patients and actually result in improved access and quality of care. This message was part of a set of seven recommendations that ACP submitted as testimony to the Senate Health, Education, Labor and Pensions (HELP) Committee's hearing on Stabilizing Premiums and Helping Individuals in the Individual Insurance Market for 2018: Health Care Stakeholders.

"We appreciate that the Chairman and ranking member of the HELP committee have decided to hold bipartisan hearings on the issues in the individual insurance market," said Jack Ende, MD, MACP, president of ACP. "We applaud this return to regular order and the opportunity it allows for physicians and other interested stakeholders to provide their expert advice and analysis on ensuring that our millions of patients continue to have access to critical health coverage in the future."

ACP made the following recommendations:

  • Congress must commit to continuation of the Affordable Care Act's cost-sharing reduction payments to insurers for the long-term. These payments offset the costs insurers occur in reducing the burden of co-payments, deductibles and coinsurance for low-income persons, as required by law. Without a guarantee that they will continue, insurers will have no choice but to leave the exchanges or raise premiums.

  • Congress should encourage reinsurance and stabilization efforts through state waivers, without weakening protections that guarantee patients access to coverage for essential health benefits or protection from excessive co-payments or deductibles.

  • Congress should adequately support and fund a robust outreach to encourage patient enrollment in health coverage. Recent actions by the administration to cut funding for advertising to consumers, and for the navigator program that helps consumers find insurance, are steps in the wrong direction. Evidence suggests that efforts such as enhanced television advertising can increase enrollment. ACP strongly believes that more intensive outreach and enrollment efforts will be needed because the open enrollment period for 2018 was considerably shortened.

  • Congress must ensure that the administration effectively enforces the requirement to purchase a qualified health plan. Not enforcing the insurance mandate penalty will lead directly to enrollment rates dropping among healthy enrollees who may be less inclined to purchase health insurance. Insurers would need to increase premiums to compensate for the resulting sicker risk pool. Any alternatives to the individual insurance requirement must be shown to be equally or more effective in getting people, especially younger and healthier ones, to sign up for coverage.

  • Congress should enact a public option that would provide more options and increase competition in the market places. Currently, exchanges in some states are having difficulty attracting enough insurers and patients may have only one insurer from which to obtain coverage. One potential approach could be to offer a buy-in program for Medicare or another public health program. ACP supports the development of a Medicare buy-in option for older adults. This type of program could expand access to providers and continuity of care for individuals changing over to Medicare, while at the same time it could help to reduce premiums for individuals in the health insurance marketplaces.

  • States might consider using the ACA's existing authority to sell insurance across state lines, subject to having an agreement among them on regulation of the products that would be sold. However, Congress should not enact legislation that would allow sale of insurance across state lines absent an appropriate regulatory structure among the states to protect consumers from a "race to the bottom" in coverage and benefits. The available evidence is that selling insurance across state lines may not have a large impact on patient choice, access to care, or premiums.

  • ACP supports the concept of state innovation in designing ways to strengthen and improve the individual insurance market and believes that Congress should be supportive of such efforts. However, ACP strongly believes that essential health benefits and other consumer protections as required by the ACA must be maintained and would oppose efforts to give states the ability to modify or reduce these benefits.

"We greatly appreciate the Committee inviting input from the physician community and the opportunity to provide recommendations on strengthening the health insurance market, and stand ready to work with the committee on the development of any reforms where our experience and expertise could be of value," concluded Dr. Ende.

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