Medical Device Daily

Everyone's pitching plans when it comes to healthcare reform.

Presidential candidates on both sides of the partisan coin - though perhaps more on one side than another - are pitching plans; physicians' groups are pitching plans; Congress is pitching plans. There's just a whole lot of plan-pitching going on.

So it should come as no surprise that the insurance industry has come up with a reform plan of its own.

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.

A year ago, AHIP advanced a proposal to develop a plan for providing universal coverage. And in June the board then 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 Medical Device Daily. "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 last year that this was the main domestic issue the U.S. needs to face ... regardless of the upcoming presidential election."

Here's a look at the three part proposal:

Under the first recommendation 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 onea-nd-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 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.

But questions remain on how many uninsured people under current healthcare policy and regulations these plans would cover.

According to a new survey from the AHIP, nearly 11% of all individuals who apply for coverage aren't offered a policy after the insurers review their medical conditions, and nearly 30% of individuals who are in their 60s, but to young for Medicare, are denied coverage.

AHIP has said it realizes these proposals aren't the say all or be all for healthcare reform but that these recommendations can help states and private insurers work with one another to provide coverage, particularly in those cases where insurers try to address shortcomings of the individual market.

In another recent proposal, about a week ago the American College of Physicians (ACP; Washington), which staunchly advocates a pluralistic payer health system, reported that it would now support a single-payer system.

The 124,000-member group cited weaknesses within a pluralistic payer system - saying that a single-payer system is the only real choice for universal healthcare at a cost the public could afford.

ACP officials did not immediately have a comment on AHIP's proposal.

"The college would need to review the proposal a lot more thoroughly against its policy," an ACP spokesman for the organization told MDD via email.

AHIP is a national association representing nearly 1,300 members providing health benefits to more than 200 million Americans. AHIP says that it and its predecessor organizations have advocated on behalf of health insurance plans for more than six decades.

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