Internists tackle key health reform issues

Monographs addressing individual mandates, tax exclusion and a public plan option were released today by the American College of Physicians (ACP). The new policy papers are:

• Individual Mandates in Health Insurance Reform
• Reforming the Tax Exclusion for Health Insurance
• A Public Plan Option in a Health Insurance Connector

"These monographs provide an evidence-based analysis of three key issues being considered by Congress as it crafts health reform legislation," noted ACP President Joseph W. Stubbs, MD, FACP. "They provide our perspectives on how to craft a requirement that all persons obtain health insurance coverage, on the advisability of limiting the tax exclusion for health insurance provided by employers, and how a public plan option might be appropriately structured to ensure choice and access to physician services."

All three monographs were developed and approved by ACP's Health and Public Policy Committee before being provided to its Board of Governors and councils for comments. Finally, they were adopted by ACP's Board of Regents at its July meeting.

The monographs answer such questions as:

• Should individuals be required to have health insurance coverage? If so, under what conditions and linked to other reforms?
• Should the tax exclusion of employer-provided health insurance be capped to provide revenue for health reform and achieve other policy goals? If so, how should such a cap be designed and linked to other reforms?
• Should the public be able to enroll in a "public plan" offered and administered by the federal government in addition to qualified private health insurance plans? If so, how should such a public plan be designed to be consistent with other ACP policies and linked to other reforms?

In the Individual Mandates monograph, ACP says it believes that every American deserves access to quality health care and supports individual mandates in efforts to reform health care in the United States when coverage is made fair, accessible and affordable. While individual mandates are a way to reform the health care system and achieve universal coverage, ACP believes they can only be implemented in a way that will not make such a requirement punitive, especially to low-income Americans.

ACP's Tax Exclusion monograph notes that the tax exclusion for employer-sponsored insurance has helped millions of American obtain affordable health insurance through their workplace. However, the current system disproportionately benefits upper income people and does not benefit low-income people who do not owe income taxes, the self-employed, and people with individual market insurance.

"A comprehensive health care reform initiative will be expensive and one way to at least partially fund such an effort is to cap the tax exclusion for employer-sponsored health insurance," ACP's monograph says. "Savings from the cap could be directed toward insuring those who do not have insurance coverage. Implementing a cam would need to be done in a way that considers the needs of low-income people who have employer-sponsored insurance. And should reflect variations in insurance costs due to firm size, health status, and practice expense."

ACP believes that a cap should be coupled with reforms to ensure that a core set of benefits is available.

The Public Plan Option monograph approved by ACP considers the pros and cons of the public plan option competing with private insurance products in a health insurance connector or exchange. ACP conditionally supports the establishment of a public plan option as part of a comprehensive health care reform proposal.

"A public plan option that competes on a level playing field with private insurers could help facilitate delivery system change, reduce costs, and ensure stability in the market," ACP says in its monograph. Establishing fair regulations that apply the same standards to both public and private insurance plans for minimum benefit packages, premium rating, and plan accessibility should help avoid unintended adverse consequences.

However, ACP also says that separate, independent entities should be established for objective governance of the health care connector and the public plan option. For a public plan and the health insurance connector to operate effectively and fairly, the health care delivery system must be reformed to strengthen primary care and a new provider payment model should incentivize care coordination, reward positive health outcomes, and promote use of best practices and effective drugs and devices. Physician and patient participation in a public or qualified private health plan offered through a connector should be completely voluntary. Further, ACP believes that safeguards would need to be established to ensure that the payment rates under a public plan are competitive with those offered by private health insurers in the same market. Together, the ACP policy papers help support the College's efforts for coverage, support for the primary care workforce, payment and delivery system reform, based on long-standing policies that have been adopted by the organization.

Source: American College of Physicians