WASHINGTON – The American College of Physicians waded further into the healthcare reform debate this week, releasing three policy papers addressing individual mandates, tax exclusion and a public plan option.

The new policy papers are "Individual Mandates in Health Insurance Reform," "Reforming the Tax Exclusion for Health Insurance" and "A Public Plan Option in a Health Insurance Connector."

"These monographs provide an evidence-based analysis of three key issues being considered by Congress as it crafts health reform legislation," said ACP President Joseph W. Stubbs, MD. "They provide our perspectives on how to craft a requirement that all persons obtain health insurance coverage, on the advisability of limiting the tax exclusion for health insurance provided by employers, and how a public plan option might be appropriately structured to ensure choice and access to physician services."

All three were adopted by the ACP's Board of Regents at its July meeting after being developed by the organization's Health and Public Policy Committee.
 
Stubbs said they answer such questions as:

1. Should individuals be required to have health insurance coverage?
2. Should the tax exclusion of employer-provided health insurance be capped to provide revenue for health reform and achieve other policy goals?,
3. And should the public be able to enroll in a "public plan" offered and administered by the federal government in addition to qualified private health insurance plans?

In the "Individual Mandates" monograph, the ACP says every American deserves access to quality healthcare and supports individual mandates in efforts to reform healthcare in the United States when coverage is made fair, accessible and affordable.

The ACP believes individual mandates can only be implemented in a way that will not make such a requirement punitive, especially to low-income Americans.

The "Tax Exclusion" monograph notes that the current tax exclusion for employer-sponsored insurance disproportionately benefits upper-income people and doesn't benefit low-income people who do not owe income taxes, the self-employed and people with individual market insurance.

"A comprehensive healthcare reform initiative will be expensive and one way to at least partially fund such an effort is to cap the tax exclusion for employer-sponsored health insurance," the paper's authors write. "Savings from the cap could be directed toward insuring those who do not have insurance coverage. Implementing a cap would need to be done in a way that considers the needs of low-income people who have employer-sponsored insurance and should reflect variations in insurance costs due to firm size, health status and practice expense."

Stubbs said the ACP believes that a cap should be coupled with reforms to ensure that a core set of benefits is available.

The "Public Plan Option" monograph "conditionally supports" the establishment of a public plan option as part of a comprehensive healthcare reform proposal.

"A public plan option that competes on a level playing field with private insurers could help facilitate delivery system change, reduce costs and ensure stability in the market," the monograph says. "Establishing fair regulations that apply the same standards to both public and private insurance plans for minimum benefit packages, premium rating and plan accessibility should help avoid unintended adverse consequences."

The ACP also notes, however, that separate, independent entities should be established for objective governance of the healthcare connector and the public plan option. For a public plan and the health insurance connector to operate effectively and fairly, the organization says, the healthcare delivery system must be reformed to strengthen primary care and a new provider payment model designed that incentivizes care coordination, rewards positive health outcomes and promotes the use of best practices and effective drugs and devices.

Stubbs said physician and patient participation in a public or qualified private health plan offered through a connector should be completely voluntary. The organization believes that safeguards would need to be established to ensure that the payment rates under a public plan are competitive with those offered by private health insurers in the same market.

The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 129,000 internal medicine physicians, related subspecialists and medical students.