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December 23, 2007 at 02:00 PM
Hoping to reduce the number of uninsured, America’s Health Insurance Plans, on Dec. 19, unveiled a series of recommendations for states to increase coverage rates in the individual market.
“We are clearly on the platform of wanting to get all Americans covered,” says AHIP President and CEO Karen Ignagni. The recommendations, she adds, are designed to help those states that want to enhance already existing high-risk pools for healthcare coverage or are considering universal coverage options.
The recommendations were designed to ensure that individuals would have guaranteed access to healthcare coverage regardless of their income or prior conditions, Ignagni says. Additionally, she notes, the recommendations would establish mechanisms to increase transparency and protect consumers, such as third-party review for rescission decisions.
The first part of the recommendations, which AHIP says states can implement now, is the establishment of a guaranteed access system for those uninsured individuals with high expected medical costs. If an individual does not qualify for that plan, health plans would then provide that individual with coverage on a guarantee issue basis and a cap on premiums of 150% of the standard rate.
“Health insurance plans believe that everyone should have access to affordable health care coverage regardless of their health status or income,” says Don Hamm, President and CEO of Assurant Health and chair of AHIP’s Access Subcommittee. “We look forward to working with states to achieve this goal immediately.”
For insurers, the AHIP proposals call for operational reforms designed to increase consumer confidence, including a limitation of pre-existing condition exclusions, the restricting of rescission actions, and establishing a new review process for those decisions. “That will give individuals the assurance that they can have their issues reviewed by a third party,” Ignagni says.
While states examine new and different ways of increasing the number of insured, Ignagni says it is important that they examine the shortcomings of past efforts. AHIP commissioned a study of prior guaranteed issue laws by Milliman, Inc., which found that they had the opposite effect from what was intended, resulting in increased premiums, lower individual enrollment and a flight from the state by health insurers. “It’s very important, as we go forward, that we not repeat the experience of the past that didn’t work,” Ignagni says.
