Robert Lawson | Feb 25, 2017

AMA applauds rejection of health insurance mergers

Trial courts have blocked two health insurance mergers that would have created what the president of the American Medical Association (AMA) described as "a threat to the affordability, accessibility and quality of health care.”

AMA President Andrew Gurman, wrote an opinion piece for the AMA’s online publication AMA Wire recently.

The decisions prevent Anthem from acquiring Cigna and Humana from merging with Aetna.

“These rulings are victories of great magnitude for our patients and the health care system,” Gurman said. “They are the result of one important factor — that physicians came together to protect patients, our profession and our health care system from further consolidation.”

Gurman also said the Anthem court rightly decided that “an enhanced ability to coerce physicians to accept lower reimbursement is not an efficiency defense, would not benefit patients, and ‘would erode the relationship between insurers and providers’ and ‘reduce the collaboration’ that is essential to innovation in payment and delivery.”

Gurman testified in a judiciary committee in 2015 and said he saw a strong resistance build over the next 15 months among those in the medical profession. He argued that people in the courtroom were particularly interested when he was called upon following others who were not part of the medical community.

“They wanted to know who was the doctor in the room,” Gurman said. “And that goes to show you that, when physicians are in a position to speak up for our patients and ourselves, people listen.

Gurman told the court that an Aetna-Humana merger would erode competition in Medicare Advantage plans across more than 350 U.S. counties.

"U.S. District Judge John D. Bates also set a notable legal precedent by recognizing Medicare Advantage as a separate and distinct market that is not in competition with traditional Medicare — a major focus of our efforts," Gurman said. "We are pleased with Judge Bates' further conclusion that the Aetna-Humana merger would have substantially lessened competition in the sale of individual commercial insurance on the public exchanges in three counties in Florida."

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