The board of America's Health Insurance Plans (AHIP; Washington) has presented a three-part proposal that it says will guarantee access to healthcare coverage in the individual market, and it is supporting third-party review of rescission decisions (rescinding or annulling), a commitment to limiting pre-existing condition exclusions.

In 2006, AHIP advanced a proposal to develop a plan for providing universal coverage. And this past June, the board established an Individual Market Task Force to examine this issue and put forth both policy and operational recommendations.

"[With this proposal] we're saying that we need to do our part," Mohit Ghose, a spokesman for AHIP, told Biomedical Business & Technology. "And that [healthcare] reform needs to come from the public and private sector."

Ghose said that the upcoming presidential election and the candidates' debates concerning their various plans, had nothing to do with AHIP's decision to come up with a healthcare reform plan.

"We're glad that there is national debate," Ghose said. "[AHIP] said in November of [2006] that this was the main domestic issue the U.S. needs to face … regardless of the upcoming presidential election."

Under the first recommendation of the plan, states would establish Guarantee Access Plans to provide coverage for uninsured individuals with the highest expected medical costs.

AHIP said if an individual isn't eligible for coverage through the Guarantee Access Plan, health plans would then provide coverage to that individual on a guaranteed issue basis with premiums capped at one- and-one-half times the standard rate.

Second, the proposal includes a series of operational reforms to give consumers peace of mind when purchasing individual healthcare coverage. These reforms include limiting the use of pre-existing conditions exclusions, restricting rescission actions, and establishing a new third-party review process for pre-existing conditions and rescission decisions.

Specifically, the AHIP board is recommending that health plans waive the application of pre-existing condition exclusions for medical conditions that are disclosed and should limit rescission actions to those based on information that should have been included in a complete and accurate response to questions asked in a clear and understandable application.

Third, the proposal outlines five critical steps that states would need to follow if they seek to achieve universal participation, principally by requiring that every citizen in the state have healthcare coverage. If a state takes these steps and achieves universal participation, health insurance plans could then guarantee coverage to all applicants, without regard to pre-existing medical conditions.

To achieve universal participation, states would need to develop an insurance coverage verification system; enforce the requirement to purchase and maintain coverage; establish an automatic enrollment process; provide premium subsidies for moderate- and low-income individuals and families; and secure funding for the coverage initiatives from a broad base of sources.

"This initiative is a fundamental repositioning," said Karen Ignagni, president/CEO of AHIP. "Our board is committed to ensuring that no American falls between the cracks of public and private programs and those individuals can have their disputes reviewed by an objective party."

The next step is to draft these proposals in some type of legislative language to give to states, Ghose said, adding that AHIP is very much at the beginning of this process.

AHIP is a national association representing nearly 1,300 members providing health benefits to more than 200 million Americans.

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