Passage of the ACA was a big improvement on the status quo at the time. However, there are problems that need to be addressed. Health reform is a journey not a destination. It should represent constant striving for better coverage, affordability, choice and access to high-quality care. That is why the AMA supports fixes to stabilize the individual insurance market and improve choices and options for patients.
Many families are not eligible to get premium and cost-sharing subsidies to purchase coverage on the ACA exchanges because of a so-called “family glitch” where a father or mother is only offered employer coverage as individual and not for the family but the family is not then eligible for coverage through an ACA exchange. This “family glitch” has affected an estimated 10.5 million adults and children, according to HHS’ Agency for Healthcare Research and Quality.
The AMA also supports demonstration projects to improve the affordability of bronze-level plans on the ACA exchanges. Now, individuals and families eligible for cost-sharing support under the ACA only get it if they purchase a silver-level plan. They forego that by getting a bronze-level plan, but these plans often come with higher deductibles, out-of-pocket maximums and co-payments that could wrongfully discourage patients from seeking the medical care they need. The AMA believes there is a role for pre-funded health savings accounts to help patients who skip cost-sharing subsidies by enrolling in a bronze plan.
There are other priorities that will guide the AMA as it works, on a nonpartisan basis, with Congress and the president to improve the nation’s health system. Those objectives are to:
- Maintain key insurance market reforms, such as coverage for pre-existing conditions, guaranteed issue and parental coverage for young adults.
- Stabilize and strengthen the individual insurance market.
- Ensure that low- and moderate-income patients are able to secure affordable and adequate coverage.
- Ensure that Medicaid, the Children’s Health Insurance Program and other safety net programs are adequately funded.
- Reduce regulatory burdens that detract from patient care and increase costs.
- Provide greater cost transparency throughout the health care system.
- Incorporate commonsense medical liability reforms.
- Continue the advancement of delivery reforms and new physician-led payment models to achieve better outcomes, higher quality and lower spending trends.
These objectives are based on a comprehensive vision for health-system reform refined over more than two decades by the AMA’s House of Delegates, which is composed of representatives of more than 190 state and national specialty medical associations.
In the coming weeks, AMA Wire will be exploring these objectives in a series of articles aimed at helping physicians and residents of all specialties, medical students, policymakers and patients understand the policies that form the basis of the AMA’s advocacy. The aim is to contribute to a constructive debate in this critical area of national policy.