MSNVA ACA Reform Survey Results and Position

February 8, 2017 - By Claudia Tellez, Executive Director, MSNVA

MSNVA ACA Reform Survey

The Medical Society of Northern Virginia’s mission is to advocate on behalf of community physicians to improve economic conditions for small/independent practices, maintain high standards of quality care for patients and advocate for reimbursement parity and fair payments for independent physicians. 

While the Accountable Care Act (ACA) expanded health insurance to low-income populations funded through tax dollars and a mandate that penalizes healthy middle-income Americans with high insurance premiums and deductibles, insurance companies are not mandated to take any risk with such coverage expansion or even contribute to the subsidies in any way.

Instead, insurance companies have been given carte blanche to create payment structures that penalize physicians by not paying them for services rendered and have added onerous administrational steps for claims submission. The reality is that independent physicians are not being paid for the sixty-three different preventive care services insurance plans are now required to cover for their subscribers under the ACA. And because the ACA also mandates that these preventive services be provided without out-of-pocket costs to subscribers, physicians have very little recourse to recoup costs assoicated with these services.

The ACA has also given insurance plans far more latitude to extort physicians into participating in exchange plans by including an “all-products” clause into their service agreements.  Lastly, the ACA has resulted in higher insurance premiums with even higher deductibles and additional out-of-pocket costs for patients, which are forcing them to defer medical care when it is needed. To this end, the MSNVA Leadership and its more than 1600 members urge Congress to prioritize the following items as part of any and all ACA reform efforts. 

  • Reduce administrative burdens for small/independent practices
  • Tax credits: Allow independent physicians to write off charity care or non-payment of patient fees
  • Tort reform
  • Payment parity for independent physicians
  • Stop Medicare payment reductions and penalties for independent physicians
  • Allow commercial insurance and Medicare beneficiaries to enter into contracts with participating and non-participating healthcare providers without penalty 
  • Eliminate narrow physician networks from insurance plans
  • Allow independent physicians to enter into collective bargaining agreements through professional associations.

 

Now that there is agreed legislation from the House leadership that will be marked up by the committees of jurisdiction, we write to offer
our views about the policy options that are under consideration in the American Health Care Act (AHCA).

Medicaid:
MSNVA supports the provisions in the AHCA to cap future federal contributions to Medicaid and phase out the higher federal match in
states that have opted to expand Medicaid. Block granting ensures equitable distribution of Medicaid dollars to states with more
indigent populations.

Premium and cost-sharing subsidies:
MSNVA supports the AHCA’s age-based tax credits and reduction of cost-sharing subsidies. Insurance companies receiving any
payments from federal subsidies should bear some risk. While the ACA expanded health insurance to low-income populations funded
through tax dollars and a mandate that penalizes healthy middle income Americans with high insurance premiums and deductibles,
insurance companies are not mandated to take any risk with this coverage expansion or even contribute to the subsides in any way.

Pre-existing conditions:
The MSNVA supports the AHCA’s continuous coverage requirements for patients with pre-existing conditions but opposes the 30
percent premium penalty for people who lose continuous coverage for 63 or more days. There should be a provision to cap insurance
premium rate increases at 5% annually, particularly for healthy populations.

Essential Health Benefits (EHB):
The MSNVA supports the AHCA’s 10 essential health benefit (EHB) categories and the repeal of actuarial value requirements.

MSNVA letter to Congress

Please contact the MSNVA Staff wth any questions and/or comments

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