Last week, America’s Health Insurance Plans (AHIP) unveiled a proposal to reform the U.S. health care system. The AHIP plan aims to help working families afford coverage, and provide support to states that enable all of their citizens to have coverage. The proposal builds on the current health care system by establishing public-private partnerships in which all stakeholders share responsibility.

AHIP’s five-point plan would:
• Improve the State Children's Health Insurance Program (SCHIP) to cover all uninsured children from low-income families;
• Expand Medicaid to cover all uninsured adults living in poverty;
• Establish a child health care tax credit for working families;
• Create a new tax-free health care account that can be used to pay for any type of coverage; and
• Create a new incentive grant program to assist states in expanding access.

A key piece of the plan is a modified guarantee-issue proposal in which states would create Guarantee Access Plans to provide coverage for uninsured individuals with the highest medical costs—those incurring costs more than two-times the state average. The premiums for these plans would be capped at 150 percent of the standard market rate. Health plans would provide information to individuals about the new Guarantee Access Plan, and would guarantee coverage to all applicants who are not eligible for the Guarantee Access Plan.

Though not explicitly prohibiting the practice of medical underwriting, AHIP’s plan does propose to limit the ability of insurers to drop coverage based on medical status, and calls on states to create a third-party review process to handle disputes involving pre-existing condition exclusions. The proposal also outlines the need for all communications between insurers and individuals to be clear and easy-to-understand.

An integral piece to NSBA’s proposed health care reform—the end goal being universal coverage—is a requirement that all individuals have health insurance. The AHIP plan comes short of endorsing an individual mandate, however they do identify five critical steps that states would have to follow to achieve universal participation:
• Develop an insurance coverage verification system;
• Enforce the requirement to purchase and maintain coverage;
• Establish an automatic enrollment process and be prepared to provide backstop funding if individuals do not fulfill their responsibility to purchase coverage;
• Create a premium subsidy program for moderate- and low-income individuals and families, as well as provide additional assistance for those with high health care costs; and
• Fund coverage initiatives from a broad base of sources.

AHIP proposes improving quality through the establishment of a national entity to evaluate and compare the safety, efficacy and cost effectiveness of new and existing health care treatments. The plan also calls for accelerating efforts to give patients and their physicians the information they need to make value-based health care decisions, and the adoption of best practices. Finally, AHIP outlines their support for a new way to handle medical liability through a medical dispute resolution system. AHIP represents nearly 1,300 health insurance providers nationwide.