AMA Calls for Coverage Expansion, SGR Repeal

Undeterred by the results of the midterm elections, the American Medical Association is urging states that have rejected Medicaid expansion programs "to develop expansion waivers that help increase coverage options for their low income adult residents."

The American Medical Association is calling for expansion of health insurance coverage for adults in states that rejected Medicaid expansion under the Patient Protection and Affordable Care Act, and renewing the call for repeal of the sustainable growth rate formula.

The policy statement emerged this week from the AMA's annual House of Delegates meeting in Dallas, TX just days after Republican victories in the Nov. 4 midterm elections. Republicans flogged Obamacare for months on end during the campaign season, and many elected officials and pundits believe the PPACA may be in for more turbulence now that Republicans control the House and Senate.

In addition, Republican, or Republican-leaning governors in five states that opposed Medicaid expansion were re-elected last week, further reducing the likelihood of a program expansion.

Still, the nation's largest, oldest physicians association was undeterred.

"The AMA is sensitive to state concerns about expanding Medicaid in a traditional manner, but we believe they must find ways to expand health insurance coverage to their uninsured populations, especially as coverage disparities continue to grow between expansion and non-expansion states," AMA Immediate Past Board Chair, David O. Barbe, MD, said in prepared remarks.

"We encourage states that would otherwise reject the opportunity to expand their Medicaid programs to develop expansion waivers that help increase coverage options for their low income adult residents."

In his Saturday address to the House of Delegates, AMA President Robert Wah, MD, spoke with zeal about renewing efforts to repeal the SGR:

"Last spring we made another run… and achieved what we didn't have before—a framework to end the SGR, with bipartisan and bicameral support, backed by more than 600 physician groups. We're now delivering this message: Congress must eliminate the SGR in the lame duck session. Why? Because it's essential to sustainable practice and preserving access… It might not happen during this lame duck session, but the end of SGR is not a matter of if, but when."

The AMA also called on the Centers for Medicare & Medicaid Services to "approve waivers that are consistent with the goals and spirit of expanding insurance coverage. The policy also urges that states use a transparent process for evaluating the success of their efforts to expand access to care and to report the results annually on their Medicaid websites." 

In other action this week, the AMA House of Delegates:

• Urged that health insurance companies strengthen privacy policies to prevent the potential disclosure of sensitive medical information outside of the confidential patient-physician relationship.
• Called for CMS to discontinue assessing penalties in the Meaningful Use program. While supporting interoperability, the AMA says attestation numbers show only 2% of physicians have demonstrated Stage 2 Meaningful Use.
• Called on calls for insurers to make any provider terminations without cause prior to the enrollment period so patients can select health plans that will cover care provided by their existing physicians. Currently, AMA says, inaccurate or late revised provider directories are leaving patients stuck with plans that dropped their physicians after they enrolled.

Wah also spoke of the need for "coverage and reimbursement of telemedicine services and fewer restrictions in Medicare." CMS's final physician fee schedule which is effective January 1, 2015, includes provisions that will pay physicians for remote chronic care management.