GOVERNMENT & MEDICINE

AMA to oppose health insurance mandates

New benefits unrelated to patient protection may be fueling growth in the uninsured. More outreach in current programs also is needed.

By Geri Aston, AMNews staff. July 19, 1999.
AMNews Annual Meeting '99 coverage - AMA's Annual Meeting site.

The AMA will oppose new health insurance benefit mandates unrelated to patient protections as part of new policy to fight the problem of the rising number of uninsured Americans.

The House of Delegates approved the policy when it adopted recommendations suggested in a Council on Medical Service report.

Benefit mandates increase the cost of insurance and make it unaffordable for some individuals and employers, said Joseph Heyman, MD, a CMS member.

That view was echoed by other physicians.

"Let's not expand benefits if it has the potential to increase the number of uninsured," said Douglas Henley, MD, an American Academy of Family Physicians delegate.

About 43.4 million Americans were uninsured in 1998, according to U.S. Census Bureau data cited in the CMS report.

More outreach urged

The other recommendations adopted by the house aimed at reducing the number of uninsured Americans ask the AMA to:

• Urge the Health Care Financing Administration to require states to use its simplified four-page Medicaid/Children's Health Insurance Program application unless states can show they have a simpler form. In 1996 almost two-thirds of uninsured adults had no education beyond high school, a finding, the report noted, that underscores the importance of developing application materials that are accessible to individuals with low education levels.
• Encourage state medical associations, state specialty societies and other physician organizations to work with state agencies to develop innovative programs to expand coverage for the uninsured.
• Urge HCFA to ensure that Medicaid and CHIP outreach efforts are sensitive to cultural and language diversities in states or localities that have large uninsured ethnic populations. According to the report, 36% of Hispanic individuals are uninsured, compared with 23% of African-Americans and 14% of whites.

In addition, 45% of noncitizens were uninsured in 1997. These findings support the need for bilingual and culturally accessible outreach efforts, the CMS report stated.

Extension of existing policy

The new policy complements existing AMA policy on the uninsured, including the Association's proposal that the existing tax exclusion for employer expenditures on health insurance be replaced with a refundable tax credit equal to a percentage of individuals' or families' health insurance expenditures. The amount of insurance expense credited toward tax liability would be capped to discourage over-insurance.

The credit percentage would be inversely related to income to increase access for low-income people. People with earnings low enough that their tax liability would be less than the credit would receive a refund for the difference.

As part of the tax credit plan, the AMA supports the creation of federal legislation that would authorize the formation of voluntary choice cooperatives. These bodies could include coalitions of small employers, unions, trade associations, health insurance purchasing cooperatives, farm bureaus, chambers of commerce or churches.

The cooperatives would pool insurance risk with the goal of lowering the cost of coverage to group insurance levels.

The CMS issued a report on its study of whether existing employer health insurance purchasing alliances demonstrate the feasibility of voluntary choice cooperatives. The house voted to support continuing AMA study of employer purchasing alliances that resemble voluntary choice cooperatives.

"Existing employer health insurance purchasing alliances have contained premium costs, expanded individual choice of plans and extended insurance coverage in some cases," the CMS report concluded. "In these respects, employer alliances serve as models for individual voluntary choice cooperatives."

But employer alliances also differ in key ways from the AMA's vision of voluntary choice cooperatives. Under the AMA proposal, individuals would not be limited to insurance options offered by their employers, and individuals, rather than employers, would purchase and own their insurance policies. Individuals would be able to choose from multiple plans and perhaps many choice cooperatives, the report noted.

Those differences were not lost on AMA delegates. A handful of congressional proposals to create purchasing pools, such as association health plans and health marts, suffer from the same flaw as employer purchasing pools, said Joel Karlin, MD, a Colorado delegate. Both still allow the employer to select the available health plans and thus restrict individual choice, he said.

No model in the private sector mirrors the Association's vision, said Daniel H. Johnson Jr., MD, a former AMA president.

"We need to have the AMA go out and promote a different way of doing this," Dr. Johnson said.

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