Antitrust

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AAFP wants a level playing field in health care, which demands improvements on both sides of the antitrust coin: physicians and health insurers. Physicians must be allowed to participate fully and freely in the health care market place while health insurers should be prevented from gaining market dominance to a point that will reduce/eliminate competition.

Current Federal Trade Commission (FTC) policies on health care antitrust enforcement that prevent physicians from negotiating with health plans are particularly onerous for primary care physicians, resulting in "take-it-or-leave-it" contracts with third-party payers. Rising costs combine with static or reduced payments to challenge the economic viability of primary care practices. Yet, physicians are being forced to accept or reject entirely the contract terms of health insurance companies. This is taking place while the Department of Justice has challenged only three out of more than 400 mergers involving health insurers and managed care organizations that have occurred in the past 12 years, and where the AMA market study indicates that in 96 percent (299) of the Metropolitan Service Areas (MSAs), at least one insurer has a combined HMO/PPO market share of 30 percent or greater.