Members of the American Medical Association (AMA) House of Delegates approved new health insurance exchange policies this weekend at a meeting in New Orleans.
The AMA, Chicago, has developed the policies to respond to the exchange provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
If PPACA takes effect as written and works as expected, it will create a new system of federal and state health coverage distribution exchanges starting in January 2014.
The exchanges are supposed to create a marketplace that individuals and small businesses can use to buy high-quality health coverage with new federal subsidies.
The U.S. Department of Health and Human Services has developed exchange guidelines that give states a great deal of flexibility in designing exchanges. A state can run part or all of its exchange program, turn part or all administration over to the federal government, and choose how strict it wants to be about which health insurers and plans can participate in the exchange program.
States also are supposed to create a new Navigator program that is supposed to help low-income people, small business owners, and others who might be confused by the exchanges figure out how to use the exchanges.
The AMA’s Council on Medical Service has developed one proposal relating to exchanges and one relating to the Navigators program.
The exchange policies build on policies that the AMA House of Delegates adopted in 2009.
PPACA itself sharply restricts the ability of insurance companies and people affiliated with insurers from helping to run the exchanges. It is also not clear whether health insurance brokers can get paid to participate in the Navigators program.
AMA officials argue in a summary of the exchange system policy documents that they believe it is “imperative for physicians, as strong advocates for our patients, to be included on exchange government structures.”
Physicians involved in exchange governance should recuse themselves when potential conflicts arise, AMA officials say.