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:
- 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;
- 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;
- 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) (April 2021 BOD)