AMA opposes ‘active purchaser’ model for exchanges

The American Medical Association said Tuesday that state insurance exchanges should not try to actively negotiate with health plans.

Some consumer advocates have endorsed an “active purchaser” model, in which states empower their exchanges to negotiate with insurers and allow only certain plans into the exchange. But insurers — and now doctors — say any plan that meets the federal standards laid out in the healthcare reform law should have access to the exchanges.

The AMA endorsed the more laissez-faire approach at the close of a semi-annual meeting Tuesday.

Exchanges are supposed to be up and running in each state by 2014. The healthcare law directs the federal government to establish an exchange in any state that doesn’t set up its own. The new marketplaces were designed to foster more competition among insurance plans, and the AMA says they have the potential to succeed — as long as qualified plans aren’t turned away because of additional requirements.

Competition among insurers gives doctors more bargaining power in setting their rates.

“If health insurance markets remain highly-concentrated, or become even more so, which is a strong possibility under ‘active purchaser’ exchanges, there will continue to be an imbalance in the negotiating power between physicians and health insurance issuers,” an AMA committee said in a report on the issue.

The AMA also adopted a policy calling on states to include doctors on exchanges’ governing boards, and registered its opposition to a new recordkeeping system known as ICD-10. The new system for classifying diagnoses asks doctors to choose from about 69,000 codes, compared with roughly 14,000 in use today, according to the AMA. Doctors say adopting the new system would be costly and time-consuming.

---