At its 66th interim meeting in Honolulu earlier this month, American Medical Association delegates outlined principles for a Medicare defined-contribution system, if lawmakers seek to move the program away from its current defined-benefits structure. They also called for compensating doctors for time spent on Medicare recovery audit contractor requests.
According to the AMA, “House of Delegates did not endorse the defined-contribution model but rather established principles for such a system. The adopted policy supports retaining traditional Medicare coverage as an option for a senior to purchase with a fixed federal subsidy, along with health plan options run by private insurers. A defined-contribution system also should support increased subsidies for low-income Americans and continued funding for graduate medical education.”
Ardis Dee Hoven, MD, president-elect of AMA, said a defined-contribution program “can help ensure the sustainability of Medicare for current and future generations. This policy provides the framework to create the needed balance of access, affordability and financing, and allows seniors the choice of coverage options that include both traditional Medicare and private insurance plans. We will continue to explore the effects of transitioning Medicare to a defined-contribution program on cost and access to care.”
Here’s additional information from the AMA:
• The policy would require competing private health insurance plans to meet guaranteed-issue and renewability requirements, be prohibited from rescinding coverage except in cases of intentional fraud, follow uniform marketing standards, meet plan solvency requirements, and cover at least the actuarial equivalent of the benefit package provided by traditional Medicare.
• Defined-contribution amounts would be adjusted for beneficiary age, income, and health status.
• Defined-contribution amounts should be adjusted annually to ensure that insurance coverage is affordable for all seniors, and the amounts should reflect changes in health care costs.
• Delegates also agreed to push for legislation that would repay physicians for time and other costs associated with appealing recovery audit contractor determinations.
• Another new policy supports every physician’s ability to choose not to enroll in Medicare. The policy states the AMA will “seek the right of patients to collect from Medicare for covered services provided by unenrolled or disenrolled physicians.”
