America’s Health Insurance Plan
Various Proposals
|
Plan StatusVarious proposals
Number of People CoveredAims for universal coverage
Estimated CostNot specified, but emphasizes cost containment by getting everyone insured so that more healthy people (who previously opted out of health insurance until they became sick) have to buy insurance, and will have access to preventive health services. States will cover the costs of patients with the highest health care costs.Payment Scheme Enhance existing government-funded and individually purchased schemes, and maintain employer-based coverage. States fund health care for the most expensive cases. |
 |
Plan in Brief
- AHIP represents nearly 1,300 health insurance companies.
- States create Guarantee Access Plans (GAPs) to cover uninsured individuals with the highest medical costs.
- Private plans guarantee coverage of applicants not eligible for GAP, at no more than 150% of standard premium rate.
- Third party review of insurer's decisions.
- Commitment to limit pre-existing condition exclusions.
|
Impact on Federal Government
- Emphasis is on state-by-state solutions.
Federal grants would help states fund GAPS.
Federal Funds could contribute to Health Savings Accounts.
Impact on States
- Expands Medicaid and SCHIP.
States create GAPS to fund coverage for the most expensive, high-risk patients.
- States provide consumers with access to a third-party review for disputes with insurers.
- Might require all individuals to purchase insurance, and verify that they have.
State funds could contribute to Health Savings Accounts.
Impact on Insurers
- Transfer of highest health care risk individuals to state GAP plans.
- The number of total individuals with private insurance would increase, based on state's individual mandates.
- Would provide "assistance" to state's on how to guarantee universal coverage.
Impact on Providers
- With more people insured, providers should start seeing more patients, and many fewer of those patients would require uncompensated care.
Impact on employers
- Relieved of the effects of having too many employees or their relatives with high cost diseases.
Impact on Individuals
- Individuals whose health care claims costs are expected to be more than twice the statewide average would receive insurance through a State-based GAP plan, whose premium rates would be limited to 150% of standard market rates.
- The uninsured with estimated medical expenses below that would receive coverage through a private plan, with premiums again capped at 150% standard market rates.
Proponents/Opponents
|
| See AHIP's various proposals as a reasonable way of keeping the private, market-based health insurance system intact, reducing the burden on employers, and extending coverage to the very sick uninsured without putting a hidden tax (eg raising premiums) on everyone else who buys insurance. |
Claim that the only way to fairly provide health care to all is to have a single-government plan. Otherwise, insurers should cover all individuals and should make their profits based on their ability to improve health outcomes, not their ability to restrict health care services. Opponents say that insurers waste premium dollars on high administrative costs and over-generous executive compensation, and that insurers will doubtless raise premiums for everyone if they do accept more high cost patients. |
|
Key Targets for InvestmentStates need to determine a way to cover those with the highest medical costs..
Notable Feature
- Increases the number of insured, by making States responsible, with help from insurers, to extend coverage to the currently 'uninsurable'.
Experts' Comments“ What’s different than in 1992 is we as an industry did not have a proposal of our own…We were reactive to others’ proposals.”
Karen Ignagni,
President and CEO,
America’s Health Insurance Plans, quoted in the New York Times, December 19, 2007.
" Right now, insurers spend $50 billion a year trying to figure out how not to cover people." Hillary Clinton,
Presidential Candidate Forum webcast , Oct. 18, 2007,
|
For further reading or listening
AHIP's Guaranteed Access Plan
AHIP Issues Strategy for Health Care Quality: Healthcare Finance News
|
|
|
Interest Groups 
