OPINION: Alaska’s 80th percentile rule protects patients

Alaska physicians have taken an oath to care for our communities, protect our patients and do no harm. Unfortunately, insurance companies and special interests take no such oath. This is why it is our duty to ensure the 80th percentile rule is preserved.

The 80th percentile rule is an important regulation to protect Alaska patients and consumers from predatory practices by insurance companies. It was adopted by the state due to the volume of complaints from Alaskans that their insurance company was not paying their medical bills and Alaskans were left paying more than their health insurance policy promised. It was designed to ensure insurance companies based outside of Alaska do not pay only part of your medical bill and saddle the patient with the remainder. It protects Alaskans from insurance companies and, more importantly, the 80th percentile rule works. Multiple states have similar laws, regulations or rules; we are hardly the first or the only. The new federal No Surprises Act, touted by insurance companies as a reason to eliminate the 80th percentile rule, only provides some protection for emergency services --it does not replace the 80th percentile rule -- and is mired in litigation across the country.

Physician groups are both providers of care and employers who provide insurance benefits to employees. They report significant increases in premium rates for years like all other Alaskans -- even during the COVID-19 pandemic, when insurance companies recorded record profits. Premera, the state’s largest insurer, which is based out of state, has recently been forced to give tens of millions of dollars back to Alaska due to making more profits than is legally allowed. Any of these would have been opportunities to decrease the financial burdens of health care costs that insurers and special interests are blaming on physicians, but instead they have focused on repealing the 80th percentile rule to extract even more money from our state. Moreover, they do this while citing decades-old data and refusing to provide transparency by participating in a statewide All Payer Claims database.

Repealing the 80th percentile rule would decimate our health care system and harm Alaskans. Unlike the 1970s and 1980s, we now enjoy a robust health care system where Alaskans no longer need to travel to the Lower 48 for routine or specialty care. Health care is a major employer for Alaskans and provides well-paying jobs with good benefits, supporting the Alaska economy. Without the 80th percentile rule, our community would lose jobs and local access to health care, which will especially harm those who live rurally, do not have the means to travel, or cannot travel due to illness or frailty. Removing the 80th percentile rule and shrinking our healthcare system will have many unintended consequences, including reducing access for seniors, Medicare and Medicaid beneficiaries, and vulnerable populations. We have a moral duty to oppose repealing the 80th percentile rule.

Make no mistake: The 80th percentile rule is for consumer protection, and it protects Alaskans from predatory insurance practices.

The government has a duty and responsibility to protect its citizens from harm. Preserving the 80th percentile rule protects those of us who live and work in Alaska. Repealing the 80th percentile rule based on an advertising campaign sponsored by special interests in the hopes that increasing insurance company profits may trickle down to a tiny decrease in your insurance premium is irresponsible and dangerous.

Jessica Panko, MD, is president of the Alaska State Medical Association.

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