The country’s largest physician organization says the country should build on the success of the Affordable Care Act (ACA) to help ensure health insurance for patients rather than move to a single-payer system under “Medicare for All."
At its annual meeting in Chicago this week, the American Medical Association’s (AMA's) delegates voted to adopt a new policy that boosts its push for universal coverage by improving the ACA. The delegates also defeated a motion to remove the AMA’s opposition to a single-payer approach to health system reform, which is currently being debated in Congress where Democrats have introduced a bill to create a Medicare-for-All system.
Congress is holding hearings on a plan unveiled by progressive Democrats earlier this year that would transition the entire U.S. health system into a single-payer structure over the course of two years.
An improved ACA would emphasize providing coverage to uninsured patients rather than upending the health insurance coverage of most Americans, including the more than 156 million enrolled in employer-sponsored coverage, the AMA said in taking its position.
“Since the ACA was enacted into law in 2010, millions of Americans have gained health insurance. The policy question now is how to improve the law to ensure even more,” said Barbara McAneny, M.D., who served as AMA president over the past year, in a statement.
“We need policies to make coverage more affordable for millions of Americans—both in the premiums they pay, as well as their cost-sharing responsibilities,” she said.
The physician organization maintained opposition to Medicare for All despite a demonstration by doctors, nurses, medical students and community activists staged at the opening of the annual meeting criticizing the association’s position and urging them to support expanding Medicare to cover all Americans.
Led by the group Physicians for a National Health Program, a coalition of several hundred people protested the association last Saturday over its position, shouting, according to the Chicago Tribune, “AMA, get out of the way!"
Doctors at the meeting heard the other point of view during a speech Monday by Seema Verma, head of the Centers for Medicare & Medicaid Services. Verma, a Trump appointee, spent part of her speech explaining why she opposes Medicare for All.
The government has tried to regulate every sector of healthcare and has failed, she said. “That’s why as head of Medicare, I am deeply concerned about proposals for Medicare for All,” she said, to applause from the audience. “We can barely afford the programs we have,” she said.
“Medicare for All would enlarge our existing program and threaten its promise of health and hope for America’s seniors who have paid into it their entire lives,” she said.
The single-payer system would have a “detrimental impact on physicians,” with studies predicting lower physician reimbursements as high as 40%, she said.
While she didn’t touch specifically on the issue of Medicare for All in her inaugural address Tuesday night, new AMA president Patrice Harris, M.D., said among the organization’s core values is access to healthcare for all. “Let us commit tonight to move medicine forward again this year, as we state emphatically that health, in all its dimensions, is a basic human right,” she said.
Harris, who made history as the first African American woman to become president of the AMA, said while the ACA brought insurance coverage to millions of Americans, millions still lack coverage, and the AMA must stand against efforts to roll back those protections.
"We are no longer at a place where we can turn a blind eye to the chronic conditions that plague half of American adults, but not yet at a place where everyone has access to insurance that could lead to preventative care."— AMA (@AmerMedicalAssn) June 11, 2019
— @PatriceHarrisMD #AMAmtg
One recent survey of healthcare workers found physicians are divided on whether to move to Medicare for All. The poll found 49% favor replacing private health insurance with a new, federally financed healthcare system.
And while the AMA stood fast in its position this week, JAMA, its medical journal, published a viewpoint article from the two doctors who co-founded the Physicians for a National Health Program voicing their support for Medicare for All. While the journal has published many opinion pieces that were critical or skeptical of a single-payer system, it was the first time in more than 15 years that JAMA published a pro-single-payer viewpoint.
To strengthen the ACA, delegates adopted recommendations to support:
- Eliminating the subsidy “cliff,” thereby expanding eligibility for premium tax credits beyond 400% of the federal poverty level.
- Increasing the generosity of premium tax credits.
- Expanding eligibility for cost-sharing reductions.
- Increasing the size of cost-sharing reductions.
An AMA council report raised concerns about the cost of various Medicare-for-All proposals and how they would be paid for. The report noted that Medicare for All would increase federal spending significantly, with some estimates adding more than $32 trillion to federal spending over 10 years.