Public Health Insurance, HCQ for COVID-19 Stir Debate at AMA House of Delegates Meeting

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House of Delegates also recognized racism as public health threat, detailed plan to mitigate effects of racism

Jan. 8, 2021 (ACP) – A debate around the need for a public health insurance option and to whom such plans should be made available took center stage at the virtual November 2020 American Medical Association (AMA) Special Meeting of the AMA House of Delegates, the AMA policy-making body.

The AMA Council on Medical Service report “Options to Maximize Coverage Under the AMA Proposal for Reform,” written in response to an American College of Physicians resolution submitted in June 2019 asking the AMA to support a public option, was up for consideration at the meeting. While the report was in favor of public health insurance for individuals without private insurance, ACP lobbied to extend this option to all-comers as public insurance may provide better coverage than high-deductible, skinny private plans, explained Dr. William Golden, who chairs the ACP delegation to the AMA House of Delegates.

AMA modified the amendment so that it more closely mirrored ACP's vision, he said. “The final modified amendment recognizes that there are private options that do not offer adequate insurance, and it puts the AMA in a more generous stance to support public option alternatives to private insurance,” Golden said.

Calling this a “significant victory,” Golden added that the modified amendment “comes closer to endorsing a public option alternative that would give people an opportunity to access a more generous health insurance plan,” he said. Now the AMA can begin to lobby Congress for such public health insurance.

A public health insurance option for interested parties “would result in greater choice and competition,” said ACP President Dr. Jacqueline W. Fincher in her remarks to the House of Delegates. “[This is] particularly important given that employers have been raising deductibles and copayments for employer-sponsored coverage, making health care unaffordable for many.”

HCQ for COVID-19?

Another hot-button topic at the meeting focused on the use of hydroxychloroquine (HCQ) to treat COVID-19. A group of physicians sought to reverse an existing AMA policy that discouraged physicians from prescribing this drug to COVID-19 patients as prevention or treatment, but the House of Delegates reaffirmed the existing policy despite some media reports to the contrary.

“It was an attempt by a small vanguard to say, ‘Don't interfere with our rights to prescribe what we think is an appropriate treatment,’” Golden explained. “The House of Delegates basically turned this down and endorsed the status quo and evidence-based policy. The use of HCQ is not a reasonable approach to COVID-19 prevention/treatment.”

Also related to COVID-19, a resolution submitted by the ACP delegation, – “Creating a Congressionally Mandated Bipartisan Commission to Examine the U.S. Preparations for and Response to the COVID-19 Pandemic to Inform Future Efforts,” was passed by the House of Delegates. Originating from a resolution from the ACP Oregon Chapter that passed the ACP Board of Governors in the fall, the resolution called for the AMA to advocate for a new federal, bipartisan commission.

The AMA also explicitly recognized racism as a public health threat and detailed a plan to help mitigate its effects during the meeting. This plan includes the development and implementation of policies that aim to advance data-driven, antiracist concepts, Golden said. The House of Delegates also voted to increase funding of governmental agencies and nongovernmental organizations for research into the epidemiology of risks and damages related to racism and efforts to prevent or repair these damages. “The AMA has done a lot to improve its stance on racism in health care and to support diversity in medicine and activities and policies that reduce disparities in health care and improve access to health care,” Golden said.

The House of Delegates also adopted a policy that states physicians without a medical contraindication have an ethical duty to get vaccinated against COVID-19, and the group supported widespread telehealth adoption even after the COVID-19 public health emergency ends or is under better control.

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