Special Interest Groups

• WHAT IS ITS MISSION?
• HOW IS IT STRUCTURED?
• PRIMARY FUNCTIONS
• PROGRAMS
• BUDGET INFORMATION
• FAST FACTS
• HISTORY
• CURRENT POLITICAL ISSUES
• FUTURE DIRECTIONS
• GROUP RESOURCES
• GROUP PUBLICATIONS
• BIBLIOGRAPHY

ESTABLISHED: 1996
EMPLOYEES: 125
MEMBERS: More than 1,000 organizations
PAC: Health Plan Political Action Committee

Contact Information:
ADDRESS: 1129 Twentieth St. NW, Ste. 600 Washington, DC 20036
PHONE: (202) 778-3200
FAX: (202) 331-7487
E-MAIL: americanassociation@aahp.org
URL: http://www.aahp.org
PRESIDENT; CEO: Karen Ignagni

WHAT IS ITS MISSION?

The American Association of Health Plans (AAHP) represents more than 1,000 health maintenance organizations (HMOs), preferred provider organizations (PPOs), and other health network organizations that, together, provide health care for more than 100 million Americans. The group aims to present a strong, unified voice for the managed care industry and to present a positive image of the industry to the general public.

The group is dedicated to defending and improving managed care, a system in which groups of doctors offer care with tight controls on costs and procedures. This method of providing health care, although increasingly popular, has been criticized for sacrificing quality of care at the expense of cost. The group's "philosophy of care" states: "AAHP believes that comprehensive health care is best provided by networks of health care professionals who are willing to be held accountable for the quality of their services and the satisfaction of their patients."

HOW IS IT STRUCTURED?

The AAHP is a trade organization headquartered in Washington, D.C., headed by a chief executive officer with the oversight of a board of directors. There are seven categories of membership depending upon the type of health care provider. Members range from small local health plans to national chains. There is also an individual membership category.

Members can participate in the formulation of policy through a number of working groups and task forces on issues such as Medicare and Medicaid. Members also voice opinions through regional membership meetings and at the association's annual meeting, where national policy is formulated.

PRIMARY FUNCTIONS

The AAHP works to both protect the managed health care industry and to ensure the quality of health care for all Americans. In the legislative arena, the association attempts to influence public health care policy through several methods. First, it conducts research on a variety of health issues, and produces studies and reports that support the managed health care industry. These studies are provided to policymakers, government agencies, and the media. The AAHP often conducts clinical research in conjunction with federal health agencies such as the National Institutes of Health and the Centers for Disease Control.

The association is also an effective grassroots organizer, and has had tremendous success mobilizing health care workers and organizations to put pressure on Congress and state legislatures. The AAHP's state affairs staff offers local members how-to manuals designed to help members mobilize a network of activists at the state level. The association's political action committee is also a powerful political force; during the 1995–96 election cycle, the Health Plan PAC contributed approximately $47,000 in political contributions, with a little more than half going to Republican candidates.

As a membership organization, the AAHP also exists to serve the needs of its various members. The association helps members keep abreast of legislative and regulatory changes through a bimonthly magazine, a bulletin on government affairs, research briefs, and other publications; as well as legislative updates, bill analyses and other services. The AAHP also has a legal staff that provides advice to members, offers referrals, and acts as a clearinghouse on legal issues. Member organizations receive regular communications on new regulations, tax changes, and other legal matters.

PROGRAMS

The AAHP provides several types of education and training opportunities for members, including education forums, conferences, and seminars at which experts provide information on health care issues. In addition, the group has an Executive Leadership Program for administrators and medical directors.

The image the AAHP attempts to project for its member organizations is embodied in Putting Patients First, a set of principles to which all members are required to abide. The self-policing program is viewed by critics of managed care as an attempt by AAHP to head off new state and federal laws and regulations. But, regardless of the sincerity of the AAHP's motives, Putting Patients First requires a high standard of its members. The program's goals, according to AAHP literature, are three-fold: "To communicate the facts about how health plans work for the benefit of patients; to make it clear that the AAHP and its member plans are listening to the concerns of patients and physicians and changing when necessary to meet their needs; and to provide a mechanism for member plans to demonstrate their commitment to high standards of accountability."

The AAHP also sponsors a number of programs that support public health initiatives. In association with the American Cancer Society (ACS), the association holds an annual awareness campaign to educate women about breast cancer and the need for regular health screenings. The joint campaign began in 1996 and is held each year on Mother's Day. In 1998 more than 200 television stations ran the public service announcement that provided 500 million viewers with the thoughtful impression that "The best gift for Mother's Day . . . is more Mother's Days."

BUDGET INFORMATION

Not made available.

HISTORY

The AAHP was created in 1996 when the Group Health Association of America merged with the American Managed Care and Review Association. The merger took place gradually; in February, the group's "philosophy of care," outlining its commitment to cost-effective yet high-quality health care was released, and in March the two groups announced that the name of the merged group would be the American Association of Health Plans.

The new association was designed to give the managed health care industry a stronger and more unified voice. At the time, managed care organizations were under heavy criticism for allegations that they encouraged or forced doctors to cut corners on health care in order to keep down costs. Congress was discussing proposals for a variety of mandates on the industry. "We believe that it is time to stand up for this style of health care and face down efforts to undermine it," said George Halvorson, AAHP's chairman of the board, in early 1996.

Since its founding, the group has fought what it considers unnecessary or burdensome state and federal controls and regulations on the managed care industry. Among its tactics are direct lobbying by its officials in the halls of Congress, mobilizing its members around the United States to contact Congress and state governments, and providing studies and reports for its allies within and outside Congress. At the same time, the group has tried to clean up its own house. In December 1996, the AAHP launched Putting Patients First, a set of principles for managed care providers designed to ensure patients that managed care was not cutting corners and was, in fact, providing high-quality care.

For instance, Putting Patients First includes the assertion that "nothing in any health plan policies should be interpreted as prohibiting physicians from discussing treatment options with patients." That item was aimed squarely at allegations that some HMOs had a "gag clause" that prevented doctors from discussing options for treatment with their patients because the treatments may be costly. Some critics, however, questioned AAHP's sincerity. Dr. Jerome Kassirer, writing in the Journal of the American Medical Association, claimed that "Putting Patients First amounts to little more than a thinly veiled attempt to ward off state and federal actions to curb the abuses of managed care."

AAHP officials and members defended the program and insisted its goals were to foster better care and were not at all political. In June 1997, AAHP members at the group's annual meeting in Seattle, Washington, voted to make Putting Patients First guidelines a condition of membership. The move was seen as a way of showing critics and, more importantly, the public, that the group was dedicated to providing the best health care possible.

CURRENT POLITICAL ISSUES

Because the health and safety of patients is the primary concern of the AAHP, it becomes involved in almost every piece of health legislation and every health debate that affects the American public. The 1990s found the association involved in controversies over the safety and reliability of air bags, the availability of quality medical services for mothers and children, and women's health care issues such as research into the cause and treatment of menopause.

The AAHP also finds itself embroiled in legislation aimed directly at its system of managed health care. For instance, in 1996, Congress passed a law governing the length of stays in hospital maternity wards after an outcry that some health plans, to limit costs, were sending new mothers home too quickly. The association has fought hard, however, against new regulations, and is always quick to remind Congress of the unpredictable dangers of trying to "micromanage" the complicated health care industry. In particular, the AAHP has helped block the most comprehensive managed care reform proposal in Congress, the Patient Access to Responsible Care Act (PARCA).

Case Study: PARCA

The battle waged over PARCA illustrates how AAHP fights for the interests of the managed care industry, while at the same time trying to guarantee health care policies that have the potential to affect millions of Americans. In early 1998, reform of health maintenance organization (HMO) practices was considered one of the most important issues facing Congress. The HMO industry, although growing in popularity, had been the subject of a number of critical reports in the media and other forums. For instance, in 1996 the Journal of the American Medical Association, reported on a four-year study of 2,235 patients, which found that almost twice as many elderly patients had declined in health while under the care of HMOs compared to treatment under traditional, fee-for-service health plans.

Representative Charlie Norwood (R-Geor.) sponsored a bill that would require HMOs to allow patients greater access to medical specialists, require better disclosure of health plan benefits, and make it easier for patients to sue if they believe they were denied proper health care. By February 1998, Representative Norwood's bill had 219 co-sponsors and supporters were optimistic that the bill would pass. But the AAHP was studying the bill's potential impact and publicizing its findings. The association warned that the bill would drive up health insurance premiums and released a study concluding that a one percent increase in premiums would result in 600,000 employees losing insurance. This study led one powerful group, the National Association of Manufacturers, to ask its members to go to Washington in February to fight all new HMO regulations. The AAHP prepared more studies on the legislation's impact and publicized them in regional press conferences.

HMO reform advocates were preparing reports of their own. In February, Patient Access to Responsible Care Alliance, an organization that supported the PARCA legislation, released a study that claimed the bill would cause only a slight increase in managed care premiums, between 0.7 percent and 2.6 percent. Louise Kertesz, writing for Modern Healthcare Magazine complained in March: "This latest debate has cranked up the self-serving research machine. Special-interest groups are starting to flood the halls of Congress with reports on how the proposed legislation would help or hurt consumers (read help or hurt their cause)."

While the conflicting reports may have been confusing for some, the AAHP reports that concluded premiums would rise were apparently beginning to have some effect. For instance, the AAHP released a study projecting that Louisiana families could lose $325 in take-home pay per household in 1999 if wages were cut to offset higher health insurance. New Orleans City Business Magazine noted that HMO reforms were fueled by horror stories of managed care organizations withholding authorization of care, sometimes resulting in irreversible injury or death. "But while the public seems to want greater access to health care," the magazine reported, "they may cry foul when the costs rise. The latter is the reason some congressmen withdrew their support for the patients' rights legislation when the reality of the cost sank in."

In March, former House Speaker Newt Gingrich gave a speech strongly opposing the legislation offered by his fellow Georgia Republican. The speech was so favorable to AAHP that even members of the group were stunned. As of late 1998, PARCA's fate was uncertain. The bill was still in committee and the full House had not voted upon it.

FUTURE DIRECTIONS

While the AAHP apparently has held off the Patient Access to Responsibility Act and other legislation that would force comprehensive changes upon the managed care industry, proponents of such legislation intend to keep pushing for them. Karen Ignagni, AAHP president, has said that many such proposals "that might seem necessary today will stifle the ability of the healthcare system to remain innovative and flexible tomorrow." Rick Smith, AAHP director of policy, further added that the additional regulations under consideration could be devastating. If AAHP officials are right about the effect of proposals being considered by Congress, then the organization will have to work hard to protect its members from damaging proposals that at one point had the support of almost half the House and still apparently have a strong residual support among many members of Congress.

GROUP RESOURCES

The AAHP maintains a Web site at http://www.aahp.org that is geared toward members, but does offer extensive information both about the association and the managed health care industry. Especially useful is the AAHP's on-line research library that includes reports and briefs on managed care facts and patient health care choices, along with consumer fact sheets on issues such as women's health care. For more information about the organization, write to the American Association of Health Plans, 1129 Twentieth St. NW, Ste. 600, Washington, DC 20036 or call (202) 778-3200.

GROUP PUBLICATIONS

The group's publications include the Medical Affairs Issues Report, the Childhood Immunization Newsletter, An Introduction to Clinical Practice Guidelines, the Government Affairs Bulletin, and Guide to PPO State Laws and Regulations. For more information about AAHP publications, E-mail the Customer Action Center at americanassociation@aahp.org, call (202) 778–3269, or write to the American Association of Health Plans, 1129 Twentieth St. NW, Ste. 600, Washington, DC 20036.