CMS, AMA and coalition contribute to blocking the mergers

Monday, March 20, 2017 12:46 PM

by Michael Volz, MD, Immediate Past President, Colorado Medical Society

In a significant win for organized medicine, the physicians we represent and our nation’s patients, federal judges blocked the proposed Aetna-Humana and Anthem-Cigna mega-mergers, finding that they would have substantially lessened competition in the health insurance marketplace.

This outstanding achievement was secured in no small part due to the work of Colorado Medical Society’s professional advocates, who were actively and significantly involved in reaching this outcome. Most important, our board of directors and membership provided affirmation, testimony and information to the AMA and, subsequently, the United States Department of Justice and Colorado Attorney General Cynthia Coffman to characterize the negative impact on patients and our ability to provide care if these mergers were approved.

In a stunning affirmation of the position urged by the AMA and a coalition of 17 state medical associations including CMS, the judge of the Anthem-Cigna case concluded that an enhanced ability to coerce physicians to accept lower reimbursement is not a merger efficiency defense. Further, it would not benefit consumers and would erode the relationship between insurers and providers, and reduce the collaboration that is essential to innovation in payment and delivery.

The judge in the Aetna-Humana case found that the merger would have substantially lessened competition in Medicare Advantage and commercial health insurance markets. In an extraordinarily well-documented, comprehensive, fact-based ruling, he acknowledged that meaningful action was needed to preserve competition and protect high-quality medical care from unprecedented market power that Aetna would acquire from the merger deal.

Our work to oppose the mergers began in August 2015, during the very end of my term as president-elect, when we met with the Colorado Division of Insurance to express grave concerns about the consolidation of the health insurance market and to encourage the DOI to hold open and transparent hearings on the mergers. In September 2015, our board of directors designated the mergers as high CMS priorities and approved the development and distribution of an all-member survey on the topic.

By October, leaders representing CMS, the American Medical Association, the Medical Association of Georgia and the Connecticut State Medical Society began a strategic dialogue on forming the national-state coalition to block the mergers. We felt it was imperative to join with like-minded organizations that recognized the danger of lessening competition in the health insurance marketplace that would result in higher prices for consumers and further skew the balance of power toward the health plans.

This Block the Mergers Coalition convened for the first time in December 2015 and would go on to hold frequent coordination calls to keep the momentum rolling. Colorado spearheaded an all-member monopsony survey that was shared with other states. Together, the survey allowed the AMA to develop a crucial data set and to gather testimony from physicians around the country, sharing the results with the DOJ to build the cases to block the mergers.

Our collective work on both mergers with the AMA and the Block the Mergers Coalition is, without a doubt, a model for future advocacy success. This is the key tenet for our medical society and medicine in general: to be organized and keep in mind our mission in medicine. We should all lift up our colleagues who are members of CMS and remind them that these achievements are made possible by their support. We should also encourage our colleagues who are not members to join CMS and their local component medical society; medicine will continue to face challenges and we need to stand together with our patients. Together we are stronger.