7.1 Million Enrolled by March 31 Deadline

AMA Offers Physician Resources, Works to Ease Transition
VBCR - April 2014, Volume 3, No 2 - Health Policy
Rosemary Frei, MSc

As the clocked ticked down to midnight on March 31, many Americans rushed to enroll in health in­surance plans made available to them through the Afford­able Care Act (ACA). Ap­proxi­mately 4.2 million people had selected a Market-place plan as of March 1, 2014, less than half of the 8.8 million who have been deemed eligible,1 and 60% of the 7 million people the Congress­ional Budget Office projected for this timeframe.2 But in the 30 days from March 1 until the end of open enrollment, nearly 3 million people signed up for government-run health insurance plans, bringing the total number enrolled to 7.1 million, according to an announcement from President Barack Obama outside the White House on April 1.3

A Law That Is “Helping Millions” Citing other statistics, the President also noted that 3 million young adults have gained health insurance by staying on their parents’ plans, and millions more have been insured through the expansion of Medicaid and children’s health insurance programs. The ACA allows children younger than 26 years of age to remain on their parents’ insurance plans.

“This law is helping millions of Americans,” the President said at the April 1 press conference, “and in the coming years it will help millions more.” He acknowledged that while the ACA has allowed millions of Americans to purchase insurance, it does not mean that “all the problems of healthcare have been solved forever,” citing rising private insurance premiums and the millions of Americans who still remain uninsured.3

In addition to those concerns expressed by the President, mainstream media has also explored concerns regarding the ACA, including the impact narrow networks could have on patients with cancer or survivors whose care may not be covered under their purchased plan. For physicians and practice administrators, confusion regarding their inclusion in (or exclusion from) insurance plans’ network panels, questions about reimbursement, and uncertainty regarding the law’s 90-day grace period are lingering.

From the AMA
Ardis D. Hoven, MD, president of the American Medical Association (AMA), noted the organization’s efforts and was optimistic in a recent interview that the ACA would help ensure that every American has access to affordable, quality healthcare. Her organization has been working for years with the federal government to make improvements to the ACA and ease the transition, she said.

“As the ACA was implemented, AMA provided fact sheets and toolkits to inform both patients and physicians about aspects of the new law,” Dr Hoven stated. “We will also monitor physician and patient experiences closely so we can accurately identify problems and advocate for solutions.”

She noted in an AMA View­points article in February that “in these first months of Affordable Care Act implementation, there’s a lot of uncertainty around health plans sold through the insurance exchanges and how their lack of transparency will impact continuity of patient care.”4

“To help physicians through the transition in their practices, we are providing practical resources, including a six-step checklist we just released with the Medical Group Management Association and forthcoming resources related to managing care through a patient’s 90-day grace period,” she said.4,5 The checklist points are:

  • Double check whether your practice’s physicians are participating with ACA exchange products;
  • Determine your practice’s ability to accept new patients;
  • Train office staff who speak with callers and patients so they can readily answer questions on insurance and enrollment;
  • As with other insurance, check patient eligibility, coinsurance, de­ductibles, and copays for each visit;
  • Be prepared to discuss out-of-pocket expenses and the cost of care with each patient; and,
  • Know the essential health benefits in your state.

In addition, Dr Hoven noted that the AMA is working with state governments on a transparency campaign6 that includes model bills7 on tiered and narrow networks (to provide meaningful access to accurate physician directories, institute due process and physician-profiling protections, and honor patients’ benefits assignments), informing physicians if one of their patients is in a 90-day grace period for nonpayment of premiums, and preventing insurers from forcing doctors to participate in all of the insurers’ networks if they agree to be a part of one of their plans.

The AMA has a list of documents written by its officials between 2010 and April 2013 on the ACA implementation regulations.8 The most comprehensive statement was posted in October 2011, noting, “The new law includes many major provisions that are consistent with AMA policy and hold the potential for a stronger, better-performing healthcare system. While the new law represents a tremendous step forward on the path toward meaningful health system reform, it is not the last step, but rather the beginning.”9

The AMA generally supports many major provisions in the ACA, including increased access to health insurance and the undertaking of comparative effectiveness research. It also advocates for changes to the ACA, such as postponing penalties related to quality-reporting data and eliminating a Medicare/Medicaid enrollment fee for physicians.9

The organization is also working to modify or alter some measures. These include delaying implementation of the value-based payment modifier, modification of requirements for referring physicians to tell patients when they are referring the patients to a hospital that they own or are an investor in, and ensuring strategic advancement of electronic health information exchange and interoperability (ie, working toward a smooth exchange of healthcare information between healthcare providers and health insurance providers).10

The AMA’s Board of Trustees voted unanimously to adopt policies crafted at the 2013 annual meeting of the organization’s House of Delegates, which sought to improve the ACA and healthcare, including a call to repeal the nonphysician–provider nondiscrimination provisions of the ACA.

In addition, in early March, the AMA issued a letter to the Centers for Medicare & Medicaid Services (CMS) asking that the organization revisit the policy that allows insurers to deny or pend claims for the second and third months of the 90-day grace period. The AMA also asked that CMS require insurers to notify physicians as soon as a patient has entered the grace period for nonpayment of premiums. In addition to the AMA, 85 organizations signed the letter.11

“We encourage physicians to keep the AMA and federal government informed as implementation of the law continues,” said Dr Hoven. Physicians can send an e-mail to This email address is being protected from spambots. You need JavaScript enabled to view it. if they identify any systemic issues that have not yet been addressed.

References

  1. Kaiser Family Foundation. State marketplace statistics. http://kff.org/health-reform/state-indicator/state-marketplace-statistics-2/. Accessed April 9, 2014.
  2. Centers for Medicare & Medicaid Services; US Department of Health and Human Services. Projected monthly enrollment targets for health insurance marketplaces in 2014—information. Memo. September 5, 2013. http://waysandmeans.house.gov/uploadedfiles/enrolltargets_09052013_.pdf. Accessed April 9, 2014.
  3. Shear MD, Pear R. Obama claims victory in push for insurance. April 1, 2014. www.nytimes.com/2014/04/02/us/politics/obama-to-report-on-progress-of-health-care-law.html?_r=0. Accessed April 9, 2014.
  4. Hoven AD. ACA roll-out may have its bumps, but we’re working toward a stronger future. AMA Viewpoints. February 4, 2014. www.ama-assn.org/ama/pub/ama-wire/ama-wire.page?plckController=Blog&plckBlogPage=BlogViewPost&UID=e38cf47a-fc5f-473b-9234-c9e714c1c8f0&plckPostId=Blog%3ae38cf47a-fc5f-473b-9234-c9e714c1c8f0Post%3ae46896e6-c192-4b83-a348-e91932abeaf0&plckScript=blogScript&plckElementId=blogDest#.Uwy4UrmPJD9. Accessed April 9, 2014.
  5. American Medical Association, Medical Group Management Association. Medical practice checklist for 2014 ACA exchange implementation. www.ama-assn.org/resources/doc/washington/aca_checklist.pdf. Accessed April 10, 2014.
  6. American Medical Association Advocacy Resource Center. Health insurance exchanges state implementation transparency campaign. www.ama-assn.org/resources/doc/arc/hix-transparency-summary.pdf. Accessed April 10, 2014.
  7. State implementation of the Affordable Care Act. www.ama-assn.org/ama/pub/advocacy/state-advocacy-arc/state-advocacy-campaigns/state-health-reform/state-implementation-aca.page. Accessed April 10, 2014.
  8. AMA comments on ACA implementation regulations. www.ama-assn.org/ama/pub/advocacy/topics/affordable-care-act/ama-comments-on-aca-regulations.page. Accessed April 10, 2014.
  9. Advocating for improvements to the Affordable Care Act.
  10. www.ama-assn.org/ama1/pub/uploadmm/399/aca-advocating-for-improvements.pdf. Accessed April 10, 2014.
  11. American Medical Association. Re: advancing interoperability and health information exchange [CMS–0038–NC]. Health information exchanges comment letter. April 22, 2013. www.ama-assn.org/resources/doc/washington/health-information-ex changes-comment-letter-22april2013.pdf. Accessed April 10, 2014.
  12. American Medical Association; Medical Group Management Association; American Academy of Child and Adolescent Psychiatry, et al. Re: concerns regarding 90-day grace period in ACA-subsidized exchange health insurance. Letter. March 5, 2014.
  13. www.ama-assn.org/resources/doc/washington/aca-grace-period-sign-on-05march2014.pdf. Accessed April 10, 2014.
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