Alexander-Murray Exacerbates Flaw in ACA’s “Catastrophic Plans”

DPC physicians and patients take note!

An aspect of Alexander-Murray will exacerbate an under-appreciated flaw in ACA requirements for plans considered “catastrophic plans.”

Alexander-Murray will allow anyone to have a “catastrophic plan” as such plan is defined by ACA. ACA limits enrollment in these plans to enrollees under 30 years of age or enrollees who have a waiver. Alexander-Murray would do away with these limitations. So far so good.

Another ACA limitation on these plans — found in  ACA section 1302(e) — is that the plans will provide no benefits until the enrollee’s annual out of pocket limit has been reached, except that the plan must cover “at least 3 primary care visits.”

This will harmful to patients of DPC practices and is bad policy. It essentially forces primary care to be handled in-network — great for the insurance companies but not for the patients orthe doctors.

Ideally the requirement should be struck from ACA.  Alternately, a small change along the lines of this or something similar [in brackets] might help fix this problem:

(B)the plan provides—
(ii)coverage for at least three primary care visits, [unless the enrollee is separately contracted with a direct primary care physician, in which case the plan will refund to the enrollee an amount equal to the value of such coverage.]