Washington, D.C. - Senator Susan Collins (R-ME) will introduce an amendment to the Health Insurance Marketplace and Affordability Act, authored by Senator Michael Enzi (R-WY), to ensure that all patients retain the right to select the health care provider that best suits their needs.
The Health Insurance Marketplace and Affordability Act would pre-empt state laws to give small businesses greater ability to pool together to purchase health plans for their employees. In its current form, the bill could allow health plans to exclude a class of health care providers solely on the basis of their license or certification, restricting patients’ access to qualified professionals who are licensed or certified by state law. This is a particularly important issue in rural areas, where there simply may not be a sufficient supply of physicians to provide the care that the health plan has promised to cover.
“This bill could restrict patient access to vital health care professionals. For example, virtually all health plans cover medically necessary primary care services. Many rural residents use a physician assistant or nurse practitioner as their primary care provider, because there simply isn’t an adequate supply of physicians in the area. In these areas, if a plan only covers primary care services offered by a physician, patients will either have to drive great distances to receive the care they need or pay out of pocket for services that are supposed to be covered benefits,” said Senator Collins.
The amendment tracks similar protections that were provided for Medicare and Medicaid beneficiaries in the Balanced Budget Act of 1997. It does not require plans to expand their coverage or provide new benefits. It simply says that a health plan cannot discriminate against a health care professional solely on the basis of their licensure or certification from providing services or benefits that are covered by the plan and within their scope of practice under state law.
The Health Insurance Marketplace and Affordability Act is scheduled for Senate floor consideration this week.
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