The American Medical Association's House of Delegates passed several resolutions during their meeting this week. Most of the measures focused on addressing the two most notable public health concerns of 2020 — combating racial discrimination and addressing COVID-19's on the country's clinical workforce.
But other proposals passed during the meeting offer into the key lobbying priorities of the nation's largest physicians' organization. Here are four new AMA policies adopted this week that could affect healthcare policy over the next year.
1. Support for the "Public Option"
The AMA laid out guardrails for a public option proposal. It's the latest step in the group inching toward openness to the policy, after AMA in August 2019 dropped out of an industry coalition that is spending to stop public option proposals at the federal and state level.
AMA's principles state that a public option should be available to "those only with unaffordable coverage options," specifically focusing on low-income individuals in states that haven't expanded Medicaid and individuals that only have access to unaffordable employer coverage. That standard appears narrower than the potential enrollee population outlined in Democrats' policy platform.
AMA also called for a public option to compete on a fair playing field with other ACA exchange plans, for physician pay rates to be negotiated, and for physician participation to be optional.
"A public option should not be seen as a panacea to cover the uninsured. It should not be used to replace private insurance; rather it can be used to maximize competition," said AMA President Dr. Susan Bailey.
President-elect Joe Biden promised to push for a public insurance option on the exchanges, but the narrow split in the Senate makes it highly unlikely that he will be able to successfully pass the policy in the next two years.
2. Decrease out-of-pocket health costs
In addition to advocating for a public option, the AMA adopted recommendations for health insurers to design health plans that can ease the cost burden placed on patients with high deductibles.
The AMA recommended that state medical associations, national medical societies and employers work with payers to develop health plans that provider more affordable access to care and for employers to provide more robust education to workers on their health benefits.
"The pandemic has prominently displayed the critical barriers posed by underinsurance, with many health plans not providing affordable coverage for services to treat chronic conditions and COVID-19- related illness," said Dr. Mario Motta, an AMA board member. "The new policy encourages research and advocacy to promote innovative health plan designs that respect patients' unique healthcare needs."
Enrollment in high-deductible health plans rose from 4% in 2006 to 30% in 2019, according to the Kaiser Family Foundation.
The rise in cost-sharing within health plans has contributed to a growing number of hospitals taking on bad debt due for services that are left uncompensated due to the inability of many patients to cover their deductible amounts, with rural providers among the hardest hit.
3. Boosting access to mental health and substance use disorder treatment
The AMA wants states to receive additional federal funding to expand access to evidence-based addiction treatment. Opioid-related overdose deaths have continued to rise since the beginning of the pandemic.
In September, HHS allocated $115 million in grants to address opioid abuse within rural communities. HHS' last major funding boost to states, of $1.8 billion, came in September 2019. Opioid overdose deaths have been on the rise after two years of decline. More than 40 states have reported increases in opioid-related mortality, according to an AMA issue brief released last month.
AMA in particular wants to address the need for long-term funding and a comprehensive framework to treat substance use disorders to reduce the access gap. Nearly 4 million people ages 12 and older out of the estimated 21 million who were in need of substance use treatment in 2018 received any treatment that year, according to the U.S. Substance Abuse and Mental Health Services Administration's 2018 National Survey on Drug Use and Health.
The board of delegates also wants to support healthcare organizations to expand behavioral health and addiction treatment services for clinicians. The changes could include providing greater access to care from out-of-network providers to ensure privacy and to reduce any stigma that may occur from physicians receiving care within the same networks of care they work.
4. Protections for physician residents against sudden hospital closures
The AMA called for revised federal regulations around graduate medical education residency slots so that they are not tied to a specific hospital. The vote comes after Hahneman University Hospital suddenly closed last year, leaving more than 500 physician residents without a training program and malpractice litigation protections.
The board of delegates said reforms would include developing an application process that would allow suddenly displaced residents to match into programs at other institutions. The AMA also called for new rules that require teaching institutions to maintain a professional liability fund in the event of a sudden shutdown, as well as providing residents with an institution's financial health details.
"The AMA remains committed to ensuring that residents and fellows are safeguarded professionally and financially in the event of an unforeseen teaching hospital closure.
"It is our obligation to help mitigate any related hardships that displaced residents may face in these unfortunate situations," AMA Trustee Dr. Grayson Armstrong said. "By creating a policy playbook to plan ahead and prepare for potential shutdown circumstances, we can better assist these physicians-in-training in moving forward as seamlessly as possible, allowing them to focus on completing their training and caring for patients."
