Health Insurance Watchdog Sets Goals for Presidential Primary Season

September 18, 2015 - WASHINGTON, DC – With a federal judge's recent decision to allow a House Republican lawsuit challenging the Affordable Care Act (ACA) to move forward and last night's second Republican Presidential debate, renewed attention must be placed upon a broken health insurance system, which negatively impacts the well-being and fiscal security of Americans.

Aimed Alliance, a not-for-profit organization working to improve health care in the United States, today highlighted the shortcomings of the current system and what must be addressed by both the next president and Congress. Aimed Alliance's biggest concerns are:

Quality – At least one quarter of Americans are underinsured and cannot access treatments prescribed to them due to insurers' profit-maximizing measures. Instead, they are relegated to trying out and failing on inferior treatments, a policy referred to as "fail first."

Efficiency – Overly restrictive policies, such as burdensome prior authorization, claims denials, and appeals processes, waste time, are costly, and must be eliminated.

Ethics – The ACA prohibits insurers from denying care for preexisting conditions. Insurers circumvent this requirement by placing all treatments for certain illnesses in the most expensive "specialty tier," making those treatments unaffordable and deterring individuals from joining the plan in the first place.

Transparency – Coverage rates and co-insurance for in-network and out-of-network services must be disclosed to allow for cost comparisons among insurers and providers, and to prevent surprise bills.

Last week, a judge allowed a case to proceed that challenges whether the Obama administration improperly used funds to support discounted co-payments for low-income individuals under the ACA. If the case is successful, Congress would have to authorize certain cost-sharing subsidies annually-an authorization that it could withhold.

"From a practical standpoint, cases that challenge the ACA are not likely to succeed and serve as a distraction," said Stacey Worthy, Public Policy Director of the Aimed Alliance. "We should focus, instead, on closing the law's loopholes so it does what it was intended to do: make health care accessible and affordable to all Americans, especially those with chronic conditions who often face discriminatory barriers to treatment."

Improving health care is a defining issue for many of the presidential candidates-an issue that was inadequately discussed during last night's presidential debate.

"As primary season comes into full swing, we hope all candidates will recognize the ACA is here to stay and focus on improving the quality, efficiency, ethics, and transparency of health care delivery under the ACA," said Dr. Shannon Ginnan, Director of Medical Affairs of the Aimed Alliance. "Aimed Alliance was disappointed that none of the candidates last night chose to offer ideas on how to address these issues for the American people."

The Alliance for the Adoption of Innovations in Medicine (Aimed Alliance) is a tax-exempt, not-for-profit organization that seeks to improve health care in the United States by supporting the development and utilization of novel, evidence-based treatments. For more information, visit www.aimedalliance.org and follow @Adoptinnovation on Twitter.

For more information or to arrange an interview with Stacey Worthy, please contact Mike Rudin at mrudin@sbpublicaffairs.com
or (703) 739-5920.