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Analysis

AMA Offers Conditional Support for Public Option Health Plan

By John Commins  
   November 18, 2020

AMA President Susan R. Bailey, MD, said the "guardrails" for the public option were adopted by the AMA's House of Delegates as part of a broader effort to get more people covered.

The American Medical Association has offered caveat-laden support for some version of a public option health plan that is expected to be brought forward in the coming months when President-elect Joe Biden takes office.

AMA President Susan R. Bailey, MD, said the "guardrails" for the public option were adopted by the AMA's House of Delegates as part of a broader effort to get more people covered.

Specifically, Bailey said, the public option should be available to patients who fall into the "coverage gap" in states that have not expanded their Medicaid rolls under the Affordable Care Act; people who make too much money to qualify for Medicaid, but not enough to afford commercial coverage.

"A public option should not be seen as a panacea to cover the uninsured. It should not be used to replace private insurance; rather it can be used to maximize competition," Bailey said. "With appropriate guardrails, the AMA will examine proposals that would provide additional coverage options to our patients."

The AMA would also support providing financial assistance to buy private or public-option coverage on the ACA Marketplace for people who have access only to otherwise unaffordable employer-sponsored coverage.

The AMA guidelines also call for:

  • Public-option plans to compete "on an even playing field" with commercial plans.
     
  • Payment rates that are "similar" to those of private plans, established through "meaningful negotiations and contracts."
     
  • No mandates on physician participation.
     
  • Prohibiting federal subsidies for public option plans, which must be "financially self-sustaining."

The AMA's House of Delegates also backed auto-enrollment in Medicaid and CHIP, and in zero-premium ACA marketplace plans for the uninsured who have coverage options available to them at no cost after subsidies are included.

"The AMA believes that now is the time to build upon the ACA to cover more of the uninsured," Bailey said. "We look forward to being at the table to represent physicians and our patients to ensure that our patients are able to secure affordable and meaningful coverage, and access the care that they need."

Whether or not a Biden administration passes a public-option depends largely upon which party controls the Senate in 2021. Republicans oppose the initiative, and if they have the Senate majority, the public option likely won't even be heard in committee.

“A public option should not be seen as a panacea to cover the uninsured. It should not be used to replace private insurance; rather it can be used to maximize competition.”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.


KEY TAKEAWAYS

The AMA guidelines call for public-option plans to compete "on an even playing field" with commercial plans.

Payment rates must be "similar" to those of private plans, established through "meaningful negotiations and contracts."

Public option plans must be "financially self-sustaining" and accept no subsidies from the federal government.

No mandates on physician participation.


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