AMA House of Delegates

AMA meeting: AMA launches pre-election push on plight of uninsured

Action on SCHIP is to be followed by the release of a national health policy agenda and an advertising campaign on the insurance access problem.

By David Glendinning — Posted July 16, 2007

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The American Medical Association House of Delegates last month voted in favor of strengthening children's health care and began formulating a broad health care agenda in advance of an election year expected to focus heavily on the uninsured.

At their Annual Meeting, delegates approved an AMA policy calling for the reauthorization of the State Children's Health Insurance Program before it expires at the end of September. They also called for a commitment from Congress of $60 billion over five years in SCHIP funding. This amount would allow the program to maintain its current level of coverage and enroll the remainder of children who are eligible but not insured.

Delegates were unanimous in their support for reauthorizing SCHIP, but some argued against placing a specific price tag on the effort. Although $60 billion is considered by many experts to be the amount needed to cover all eligible kids, some physicians warned the AMA against locking itself into a specific figure when funding projections could change.

But the AMA board felt strongly that this figure was the amount required to ensure health coverage for every eligible child, Dr. Rosman said. President Bush and some lawmakers are calling for a much smaller SCHIP appropriation. After negotiations in Washington, this means the final amount could fall in the middle.

Delegates also considered other resolutions on the issue of the uninsured and underinsured. They adopted principles to guide the evaluation of health insurance coverage adequacy. For example, to pass AMA muster, insurance pools designed to enable access to coverage must offer several age-appropriate options, follow the same guidelines as those of federal health employee plans, and assist lower-income and sicker patients with high costs.

Preparing for 2008

Next year is expected to be a busy one on the issue of health access for the uninsured, and the AMA is preparing to have its say in the debate.

At the Annual Meeting, the AMA board gave a sneak peek at a national health care policy agenda it is putting together. When completed by late August, it will serve as the Association's official set of policies on a range of health care issues that could arise in the election year and beyond.

"This is the season to have these ideas heard by the American public we serve and their leaders," said AMA Trustee Cecil B. Wilson, MD. The AMA will deliver the final agenda to the White House, Congress and major political parties.

Although the package is not finalized, a discussion draft distributed at an Annual Meeting forum referenced the problem of the uninsured at the top of the "health care environment" category. Promoting such reforms as reconfiguration of tax benefits on the federal and state level, the AMA will try to help ensure fair coverage and access to care for both insured people and the uninsured. The agenda also is expected to cover the topics of clinical excellence, public health, practice viability and physician education.

This fall, the AMA will launch a three-year "Voice for the Uninsured" media and education campaign aimed at bringing more public attention to the uninsured. Using advertisements and grassroots advocacy, the AMA hopes to put pressure on Congress to pass legislation on the issue.

Several of the planned ads feature actual doctors and uninsured patients who are trying to deal with the lack of insurance, on top of the patients' medical needs. The theme of the campaign -- "Because one out of seven is 45 million too many" -- is based on statistics for the number of uninsured.

Ads and other outreach tools will direct people to a Web site (link) where they can share concerns and find information on how to contact lawmakers and candidates. The AMA board will decide by fall on how it will evaluate candidates' health reform plans against Association policies and share its assessments with members.

The house considered other policies on the uninsured, but delegates felt some went too far or needed study.

Delegates rejected a resolution that would have added publicly funded universal access to health insurance to the AMA's list of options to consider in the national health system reform debate. Opponents said the proposal was against AMA principles.

"Once we put 'publicly funded universal access to health insurance' on our approved list, we've now given cover to all politicians who wish to construct a single-payer system," said Alan W. Harmon, MD, a gastroenterologist and delegate from Jacksonville, Fla.

Other physicians said the AMA should at least acknowledge the option of publicly funded universal health care if it is going to remain an active player in the debate.

The house tabled a resolution that would have added support for health care tax deductions to the AMA's policy on the uninsured, which now calls for tax credits to buy coverage. A measure to establish AMA guidelines for reviewing state health system reforms also was referred for more study.

The board will review the referred proposals and report back at the Interim Meeting in November.

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ADDITIONAL INFORMATION

Meeting Notes: Access to care

Issue: Surgeons worry that nonphysicians could encroach upon doctors of medicine and osteopathy when it comes to performing complex surgical procedures.
Proposed action: Adopt the definition of "surgery" developed by the American College of Surgeons. [Adopted]

Issue: Medicare Advantage plans are paid higher rates than fee-for-service plans, and private fee-for-service plans "deem" physicians as participants after filing one claim.
Proposed action: Seek to eliminate subsidies to Medicare Advantage and prohibit physician deeming without a contract. [Adopted]

Issue: Some physicians worry that the gulf between Medicare payments for primary care doctors and specialists is widening.
Proposed action: Recommend the voting representation on the AMA Relative Value Scale Update Committee, which suggests how much Medicare should value each service, be changed to include more primary care expertise. [Referred for study]

Issue: Physicians are concerned the National Quality Forum could supplant the Physician Consortium on Performance Improvement in developing quality measures.
Proposed action: Oppose any effort to expand the NQF in such a way and report on the forum's activities at the Interim Meeting. [Adopted]

Issue: The federal government could consider further limiting the prices paid for drugs, medical procedures and other services.
Proposed action: Oppose price controls in the health care industry and continue promoting market-based strategies to make health care affordable. [Adopted]

Issue: Immigrants and foreign visitors often lack health insurance.
Proposed action: Support legislation requiring the government pay physicians for federally mandated care, regardless of patient immigration status. [Adopted]

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