Collective Negotiation

To improve the quality of care in the American health care system, improve access to the system, and to reduce the cost of care, primary care physicians should be granted a limited exemption from federal and state antitrust legislation, so they can effectively negotiate with health insurance companies and become stronger patient advocates.

The McCarran-Ferguson Act (15 USC §§ 1011-1015), which exempts health insurance companies from federal anti-trust legislation that applies to most businesses, has:

  • led to the consolidation of health insurance companies and thus limited competition among them, thereby giving them superior negotiating leverage with primary care physicians, and
  • given health plans extraordinary control over benefit design, coverage exclusion, patient co-pay and deductible design, and formulary design, which adversely affects patients’ welfare.

Specificially, the AAFP recommends that:

  1. America’s primary care physicians be given the same exemption from federal anti-trust legislation that is enjoyed by health insurance companies under the McCarran-Ferguson Act;
  2. Any exemption for primary care physicians from federal anti-trust legislation, as is enjoyed by health insurance companies under the McCarran-Ferguson Act, be extended to state anti-trust legislation;
  3. That primary care physicians be permitted to collectively negotiate with health insurers on matters including, but not limited to:
  • Fees for providing primary care services, including those for ancillary services they provide in their offices,
  • Monthly retainers, stipends, or capitations intended to cover care management and other non-face-to-face care, such as population management, quality improvement, etc.;
  • Utilization management (including, but not limited to, therapeutic and diagnostic denials and preauthorization processes); and
  • Any other matter that affects the quality of care received by patients.

(2011 COD) (2016 COD)