AMA House of Delegates

Innovative pay models should cover uninsured patients, says Lisa Egbert, MD. Photos by Ted Grudzinski / AMA

Delegates back state flexibility on uninsured

States should have the choice to create insurance programs, but only if they maintain coverage levels mandated under the health reform law, the AMA says.

By Charles Fiegl — Posted Nov. 28, 2011

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State governments should be given the freedom to develop new health care delivery models to cover their uninsured populations, the American Medical Association House of Delegates stated in a policy adopted at its Interim Meeting in November.

The AMA will advocate that states should have the flexibility to test and implement new health coverage models as long as the alternatives meet or exceed the level of coverage required by the health system reform law.

The new policy also calls for the alternative models to ensure that patients get their choice of physician and private health plan, and to prohibit denials based on preexisting conditions.

The resolution enhanced AMA policy that advocates for innovative pay models to cover low-income individuals, said Lisa Egbert, MD, an obstetrician-gynecologist from Kettering, Ohio, and a delegate for the Ohio State Medical Assn. A key difference was removing the specification that it apply only to poor patients -- a move that broadens the policy.

"I think we all should have that option," Dr. Egbert said.

The health reform law allows for states to opt out of certain federal mandates starting in 2017 if they demonstrate that their systems will cover just as many uninsured at the same level of coverage. Sens. Scott Brown (R, Mass.) and Ron Wyden (D, Ore.) have introduced legislation that would allow states to apply for such innovation waivers starting in 2014. President Obama has said he would support the earlier opt-out date.


Dr. Rosman

During a separate policy discussion, delegates talked about the option of capping Medicaid spending through block grants to states.

After debating the issue, the house voted for the Council on Medical Service to solicit further comments on Medicaid financing from AMA members.

Block grants are not supported by some specialty societies, such as the American Academy of Family Physicians, said Douglas Henley, MD, an alternate delegate from Leawood, Kan., speaking on behalf of the AAFP. He said a state would stop providing care once it exhausted its block grant.

"We do support reforms and innovation that takes care of the most underserved in our population," Dr. Henley said. "There are many ways to do that, that do not involve block grants."

Samantha Rosman, MD, a pediatrician from Jamaica Plain, Mass., said she doubted that the AMA would support block grants. She is an alternate delegate for the American Academy of Pediatrics.

These grants would not work in many states, such as Texas, that have large numbers of Medicaid beneficiaries and uninsured residents, said Bohn Allen, MD, a general surgeon in Arlington, Texas, and a delegate for the Texas Medical Assn.

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Meeting notes: Public health

Issue: Rules that will apply to biosimilar, or follow-on, biologics -- generic versions of biologic medicines that have no clinically meaningful differences from the original off-patent drugs that they are mimicking -- should not lead to undue delays in drug manufacturing or discourage pharmaceutical companies from making the medicines.

Proposed action: Advocate for an abbreviated approval pathway for biosimilar biologics while protecting patient safety and ensuring that physicians understand which biosimilars are merely comparable to the original drug formulations, versus those that are clinically interchangeable. [Adopted]

Issue: Adverse health effects have been documented at levels below the current National Ambient Air Quality Standards for ozone of 0.075 parts per million. In September, President Obama directed the Environmental Protection Agency to delay revising the ozone standard until 2013.

Proposed action: Send President Obama a letter to call for lowering the ozone standard to 0.060 parts per million, noting that delaying action will produce more cases of asthma, exacerbate chronic obstructive pulmonary disease, and lead to more emergency department visits, hospitalizations and deaths in the U.S. population. [Adopted]

Issue: Highly caffeinated energy drinks such as Red Bull and Rockstar may be hazardous for susceptible people, especially when combined with alcohol. There are reports of life-threatening effects such as tachyarrhythmias and highly elevated blood pressure.

Proposed action: Seek regulatory action such as warning labels through the Food and Drug Administration. [Adopted]

Issue: The Preventive Health and Health Services Block Grant, a $28 million federal program, funds a wide variety of programs targeting rape, heart disease, stroke and more. The Obama administration has proposed eliminating the program in its fiscal 2012 budget.

Proposed action: Support continuing the block grant or secure adequate alternative funding to continue offering the program services and help train the public health physician work force. [Adopted]

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